What are the guideline sources, guidelines and references for Acne vulgaris ?
Guideline sources The following summarized guidelines for the evaluation and management of acne vulgaris are prepared by our editorial team based on guidelines from the British Photodermatology Group (BPG/BAD 2019), the Global Alliance to Improve Outcomes in Acne (GAIOA 2018), the French Working Group on Acne (FWG-A 2017), the American Academy of Dermatology (AAD 2016), the European Dermatology Forum (EDF 2016), the Canadian Working Group on Acne (CWG-A 2016), and the American Acne and Rosacea Society (AARS 2013). 1 2 3 4 5 6 7 Guidelines 1. Diagnostic investigations Microbiological testing: Consider microbiological testing in patients who exhibit acne-like lesions suggestive of Gram- negative folliculitis. C Do not routinely obtain microbiological testing in the evaluation and management of patients with acne. D Endocrinological testing: Obtain laboratory evaluation for patients who have acne and additional signs of androgen excess. B https://web.pathway.md/diseases/rec9pxWO3pKKNJQ7A 1/5 6/23/23, 1:35 AM Acne vulgaris Pathway Do not routinely obtain endocrinological evaluation (such as for androgen excess) for the majority of patients with acne. D 2. Medical management Topical therapies: As per AAD 2016 guidelines, offer benzoyl peroxide as monotherapy for mild acne, or in conjunction with a topical retinoid, or systemic antibiotic therapy for moderate-to-severe acne. B Show 8 more As per CWG-A 2016 guidelines, offer the following options in patients with comedonal acne: topical retinoids benzoyl peroxide fixed-dose combinations of adapalene-benzoyl peroxide and clindamycin-benzoyl peroxide. B Show 3 more As per EDF 2016 guidelines, consider offering topical retinoids C , benzoyl peroxide, or azelaic acid in patients with comedonal acne. C Show 10 more Systemic antibiotics: As per AAD 2016 guidelines, offer systemic antibiotics for the management of moderate and severe acne and forms of inflammatory acne that are resistant to topical treatments. B Show 5 more As per CWG-A 2016 guidelines: Add systemic antibiotics to the topical therapy in patients with more extensive moderate papulopustular acne. B Offer systemic antibiotics in combination with benzoyl peroxide, with or without topical retinoids, in patients with severe acne. B As per EDF 2016 guidelines, do not use systemic antibiotics in patients with comedonal or mild- to-moderate papulopustular acne. D Show 10 more Systemic retinoids: As per AAD 2016 guidelines, offer oral isotretinoin for the treatment of patients with severe nodular acne. B Show 7 more As per CWG-A 2016 guidelines, offer oral isotretinoin in patients with severe acne. A As per EDF 2016 guidelines, do not use systemic isotretinoin in patients with comedonal or mild-to-moderate papulopustular acne. D Show 2 more https://web.pathway.md/diseases/rec9pxWO3pKKNJQ7A 2/5 6/23/23, 1:35 AM Acne vulgaris Pathway Hormonal agents: As per AAD 2016 guidelines, offer estrogen-containing combined oral contraceptives for the treatment of inflammatory acne in female patients. A Show 3 more Updated evidence: SAFA In adult women with facial acne for at least 6 months, judged to warrant oral antibiotics, spironolactone was superior to placebo with respect to improvement in Acne-Specific Quality of Life symptom subscale score at week 12. Miriam Santer et al. BMJ. 2023 May 16. As per CWG-A 2016 guidelines: Consider offering combined oral contraceptives in female patients with comedonal acne. C Add combined oral contraceptives to the topical therapy in female patients with more extensive moderate papulopustular acne. B As per EDF 2016 guidelines, do not use anti-androgens in patients with comedonal or mild-to- moderate papulopustular acne. D Show 4 more Oral zinc: consider offering oral zinc in patients with mild-to-moderate papulopustular acne. C Show 2 more Chemical peels: insufficient evidence to support the use and of glycolic and salicylic acid peels in patients with acne. I 3. Nonpharmacologic interventions Dietary modifications: As per FWG-A 2017 guidelines, do not offer any dietary restrictions to attenuate acne. D As per AAD 2016 guidelines, insufficient evidence to support specific dietary changes in the management of patients with acne. I Show 2 more Alternative and complementary therapies: insufficient evidence to support herbal and alternative therapies for the treatment of patients with acne. I 4. Therapeutic procedures Intralesional corticosteroid injections: consider performing intralesional corticosteroid injections for the treatment of individual acne nodules. C Laser and light therapy: https://web.pathway.md/diseases/rec9pxWO3pKKNJQ7A 3/5 6/23/23, 1:35 AM Acne vulgaris Pathway As per BAD 2019 guidelines, consider offering photodynamic therapy as a treatment option in patients with acne, if standard treatments are ineffective or contraindicated. C As per AAD 2016 guidelines, insufficient evidence to recommend physical modalities, including pulsed dye laser, for the routine treatment of patients with acne. I As per EDF 2016 guidelines, insufficient evidence to recommend for or against laser, intense pulsed light or photodynamic therapy in patients with comedonal, papulopustular, nodular or conglobate acne. I Show 7 more 5. Patient education General counseling: Counsel patients with acne regarding the following in order to improve adherence: treatment (except isotretinoin) is not curative treatment efficacy is not immediate, regular application and/or intake over several weeks is needed to obtain lesion improvement maintenance therapy is mandatory once remission has been obtained by the induction regimen local irritation frequently induced by topical treatments can be prevented by starting with application on alternating days and using moisturizers. B Show 2 more References 1. Zaenglein AL, Pathy AL, Schlosser BJ et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016 May;74 5 945 73.e33. Open 2. Lawrence F Eichenfield, Andrew C Krakowski, Caroline Piggott et al. Evidence-based recommendations for the diagnosis and treatment of pediatric acne. Pediatrics. 2013 May;131 Suppl 3 S163 86. Open 3. Diane M Thiboutot, Brigitte Dr no, Abdullah Abanmi et al. Practical management of acne for clinicians: An international consensus from the Global Alliance to Improve Outcomes in Acne. J Am Acad Dermatol. 2018 Feb;78 2 Suppl 1 S1 S23.e1. Open 4. A Nast, B Dr no, V Bettoli et al. European evidence-based S3 guideline for the treatment of acne - update 2016 short version. J Eur Acad Dermatol Venereol. 2016 Aug;30 8 1261 8. Open 5. Yuka Asai, Akerke Baibergenova, Maha Dutil et al. Management of acne: Canadian clinical practice guideline. CMAJ. 2016 Feb 2;188 2 118 126. Open 6. L Le Cleach, B Lebrun-Vignes, A Bachelot et al. Guidelines for the management of acne: recommendations from a French multidisciplinary group. Br J Dermatol. 2017 Oct;177 4 908 913. Open 7. T H Wong, C A Morton, N Collier et al. British Association of Dermatologists and British Photodermatology Group guidelines for topical photodynamic therapy 2018. Br J Dermatol. 2019 Apr;180 4 730 739. Open https://web.pathway.md/diseases/rec9pxWO3pKKNJQ7A 4/5 6/23/23, 1:35 AM Acne vulgaris Pathway 8. American Academy of Dermatology. Choosing Wisely AAD recommendations. Choosing Wisely. 2015. Open 9. Hywel C Williams, Robert P Dellavalle, Sarah Garner. Acne vulgaris. Lancet. 2012 Jan 28;379 9813 361 72. Open 10. Siri Knutsen-Larson, Annelise L Dawson, Cory A Dunnick et al. Acne vulgaris: pathogenesis, treatment, and needs assessment. Dermatol Clin. 2012 Jan;30 1 99 106, viii-ix. Open 11. Yuka Asai, Akerke Baibergenova, Maha Dutil et al. Management of acne: Canadian clinical practice guideline. CMAJ. 2016 Feb 2;188 2 118 126. Open 12. J K L Tan, K Bhate. A global perspective on the epidemiology of acne. Br J Dermatol. 2015 Jul;172 Suppl 1 3 12. Open 13. Anna Hwee Sing Heng, Fook Tim Chew. Systematic review of the epidemiology of acne vulgaris. Sci Rep. 2020 Apr 1;10 1 5754. Open 14. Nevena Skroza, Ersilia Tolino, Alessandra Mambrin et al. Adult Acne Versus Adolescent Acne: A Retrospective Study of 1,167 Patients. J Clin Aesthet Dermatol. 2018 Jan;11 1 21 25. Open 15. A C Perkins, C E Cheng, G G Hillebrand et al. Comparison of the epidemiology of acne vulgaris among Caucasian, Asian, Continental Indian and African American women. J Eur Acad Dermatol Venereol. 2011 Sep;25 9 1054 60. Open 16. A U Tan, B J Schlosser, A S Paller. A review of diagnosis and treatment of acne in adult female patients. Int J Womens Dermatol. 2017 Dec 23;4 2 56 71. Open 17. Miriam Santer, Megan Lawrence, Susanne Renz et al. Effectiveness of spironolactone for women with acne vulgaris SAFA in England and Wales: pragmatic, multicentre, phase 3, double blind, randomised controlled trial. BMJ. 2023 May 16;381:e074349. Open https://web.pathway.md/diseases/rec9pxWO3pKKNJQ7A 5/5