Dermatologists' group offers latest guidance on acne

It might take a combination of treatments to rein in problem acne in teens and adults, updated guidelines from the American Academy of Dermatology (AAD) suggest.

The work appears in the Journal of the American Academy of Dermatology.

The guidelines on the all-too-common condition (acne affects 85% of teens and many adults) haven't undergone a revision since 2016.

The 2024 updates include "discussion of new topical medications, which are directly applied to the skin, and systemic treatments, which are taken by mouth," explained Dr. John Barbieri, co-chair of the AAD's Acne Guideline Workgroup.

The new updates are all evidence-based, with 18 recommendations in all.

Four items fell under the guidelines' "strong recommendation" header:

• The use of benzoyl peroxide creams to curb the amount of acne-linked bacteria on the skin
• The use of retinoid creams such as adapalene, tretinoin, tazarotene and trifarotene, to help clear pores and lower inflammation
• Oral antibiotics such as doxycycline, as well as antbiotic creams, to also help lower bacteria levels and inflammation
• Combination use, as needed, of all of the above.

The AAD also had five "good practice" recommendations for dermatologists when treating acne:

• The guidelines advise "combining multiple different treatment types, as this can lead to better results."
• Use antibiotics sparingly, because overuse can trigger resistant strains of bacteria
• Using benzoyl peroxide alongside an antibiotic can lessen the risk for resistance
• Patients plagued by larger acne bumps may need injected corticosteroid therapy to more quickly ease inflammation and pain
• Folks with severe acne who've failed treatment with the creams and pills mentioned above may need treatment with isotretinoin (brand name Accutane).

Finally, the guidelines include what the AAD called "conditional" recommendations, to be considered by doctors on a case-by-case basis:

• Use of clascoterone creams, which target hormonal issues that might drive acne. As well, hormonal therapies such as use of the contraceptive pill or spironolactone might also address hormonal causes of acne
• Salicylic acid creams that might help unclog pores and exfoliate skin
• Azelaic acid creams that can be used to "unclog pores, kill bacteria, and fade dark spots that may continue when an acne spot clears"
• Minocycline or sarecycline pills, to fight acne-linked skin bacteria and to ease inflammation.

There was just too little supporting evidence to recommend other purported acne treatments, such as chemical peels, lasers and light-based devices or microneedling, the AAD said.

Evidence was also lacking to support dietary changes, or alternative therapies such as vitamins or plant-based products, the group said.

Three other "treatments" were recommended against: Use of broadband light therapy, intense pulsed light and adapalene 0.3% gel.

Overall, "We are able to offer our patients with acne more options than ever before as we work to address their concerns and determine the most effective treatment plan possible," Barbieri said in an AAD news release. "Just as important, dermatologists must have access to all available therapeutic options."