The American Academy of Dermatology (AAD) has published new guidelines for the management of acne vulgaris.
Published online in the Journal of the American Academy of Dermatology, the evidence-based guidelines cover acne treatment recommendations for both adolescents and adults.
"There are a variety of effective treatments available for acne, and dermatologists have found that combining 2 or more treatments is the best option for the majority of patients," said Andrea Zaenglein, MD, Penn State, Hershey, Pennsylvania. "Recommended treatments include topical therapy, antibiotics, isotretinoin, and oral contraceptives."
When antibiotics are used for the treatment of moderate to severe acne, the guideline recommends that topical therapy be used at the same time. Once a course of antibiotics is complete, patients should continue using topical treatments to manage their condition.
Topical medications, such as retinoids and benzoyl peroxide, also may be combined with one another to create an effective treatment regimen.
In addition, some female patients may see their acne improve with the use of oral contraceptives, which can be combined with other treatments.
For severe acne or moderate acne that does not respond to other therapy, the guidelines recommend oral isotretinoin. Because this medication carries a high risk of birth defects, females must take careful steps to prevent pregnancy while on isotretinoin, and all patients who take the drug must enrol in the federal iPledge program. While some studies have suggested a connection between oral isotretinoin and inflammatory bowel disease or depressive symptoms, the evidence is not conclusive; however, patients should be aware of these risks and carefully follow their doctor's treatment advice.
Although limited data has shown that in-office procedures like laser treatments or chemical peels may improve acne, the guidelines do not recommend such procedures for routine acne treatment. The guidelines also indicate that there is not enough evidence to recommend treating acne with alternative therapies like tea tree oil.
Some research suggests that dairy products, particularly skim milk, and diets with a high glycaemic index, such as those high in sugar and carbohydrates, may be linked to acne. However, according to the guidelines, there is not enough data to recommend dietary changes for acne patients.
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