New Guideline for Treating Acne in Children, Adults

A new guideline aims to help Canadian physicians, nurses and pharmacists treat children and adults with acne.

The guideline, published in the Canadian Medical Association Journal, updates the previous guidance published 15 years ago.

"With early diagnosis, treatment of active lesions and prevention of adverse potential sequelae, the health of the many Canadians with acne may be improved," wrote Jerry Tan, MD, Department of Medicine, Western University, London, Ontario, and colleagues.

A team of dermatologists from across the country reviewed the latest evidence and provide treatment recommendations for 3 acne presentations: comedonal acne, mild-to-moderate papulopustular acne, and severe inflammatory acne (deep pustules or nodules).

The guideline developers did not include neonatal or infant acne, late-onset acne, acne rosacea, and other variant forms.

Key recommendations include:

• For comedonal acne: topical benzoyl peroxide, retinoids or a combination of topical retinoids with benzoyl peroxide or clindamycin is recommended. If a single therapy does not work, use of fixed-dose clindamycin-tretinoin may be considered, and in women, combined oral contraceptives.
• For localised mild-to-moderate papulopustular acne: topical benzoyl peroxide is recommended. There is also strong evidence for use of topical retinoids and fixed-dose combinations. For more extensive moderate papulopustular acne, oral antibiotics or combined oral contraceptives (in women) with the above topical treatments are recommended.
• For severe acne: use of oral isotretinoin is strongly recommended, although only physicians with experience in prescribing and monitoring the drug should prescribe. Strict pregnancy preventive measures must be followed.

As provincial plans do not cover many of the recommended therapies, the authors noted that cost to patients should be a factor in deciding treatment.

To ensure healthcare professionals are aware of the guidelines, the authors are creating recommendation summaries for physician, nursing, pharmacy, and other medical organizations.