Guidelines of care for the management of acne vulgaris

J Am Acad Dermatol. 2024 May;90(5):1006.e1-1006.e30. doi: 10.1016/j.jaad.2023.12.017. Epub 2024 Jan 30.

Abstract

Background: Acne vulgaris commonly affects adults, adolescents, and preadolescents aged 9 years or older.

Objective: The objective of this study was to provide evidence-based recommendations for the management of acne.

Methods: A work group conducted a systematic review and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of evidence and formulating and grading recommendations.

Results: This guideline presents 18 evidence-based recommendations and 5 good practice statements. Strong recommendations are made for benzoyl peroxide, topical retinoids, topical antibiotics, and oral doxycycline. Oral isotretinoin is strongly recommended for acne that is severe, causing psychosocial burden or scarring, or failing standard oral or topical therapy. Conditional recommendations are made for topical clascoterone, salicylic acid, and azelaic acid, as well as for oral minocycline, sarecycline, combined oral contraceptive pills, and spironolactone. Combining topical therapies with multiple mechanisms of action, limiting systemic antibiotic use, combining systemic antibiotics with topical therapies, and adding intralesional corticosteroid injections for larger acne lesions are recommended as good practice statements.

Limitations: Analysis is based on the best available evidence at the time of the systematic review.

Conclusions: These guidelines provide evidence-based recommendations for the management of acne vulgaris.

Keywords: Acne; Cutibacterium acnes; acne vulgaris; adapalene; antiandrogens; antibiotics; azelaic acid; azithromycin; benzoyl peroxide; clascoterone; clindamycin; contraceptives; corticosteroids; diet and acne; doxycycline; erythromycin; grading and classification of acne; guidelines; hormonal therapy; isotretinoin; light therapies; microbiological and endocrine testing; minocycline; retinoids; salicylic acid; sarecycline; spironolactone; tazarotene; treatment; tretinoin; trifarotene.

Publication types

  • Practice Guideline
  • Systematic Review

MeSH terms

  • Acne Vulgaris* / drug therapy
  • Administration, Cutaneous
  • Administration, Oral
  • Adrenal Cortex Hormones / administration & dosage
  • Adrenal Cortex Hormones / therapeutic use
  • Anti-Bacterial Agents* / administration & dosage
  • Anti-Bacterial Agents* / therapeutic use
  • Benzoyl Peroxide* / administration & dosage
  • Benzoyl Peroxide* / therapeutic use
  • Contraceptives, Oral, Combined / administration & dosage
  • Contraceptives, Oral, Combined / therapeutic use
  • Cortodoxone / analogs & derivatives
  • Dermatologic Agents* / administration & dosage
  • Dermatologic Agents* / therapeutic use
  • Dicarboxylic Acids* / administration & dosage
  • Dicarboxylic Acids* / therapeutic use
  • Doxycycline* / administration & dosage
  • Doxycycline* / therapeutic use
  • Drug Therapy, Combination
  • Evidence-Based Medicine / standards
  • Humans
  • Injections, Intralesional
  • Isotretinoin* / administration & dosage
  • Isotretinoin* / therapeutic use
  • Minocycline / administration & dosage
  • Minocycline / therapeutic use
  • Propionates
  • Retinoids / administration & dosage
  • Retinoids / therapeutic use
  • Salicylic Acid* / administration & dosage
  • Salicylic Acid* / therapeutic use
  • Spironolactone* / administration & dosage
  • Spironolactone* / therapeutic use
  • Tetracyclines / administration & dosage
  • Tetracyclines / therapeutic use

Substances

  • Adrenal Cortex Hormones
  • Anti-Bacterial Agents
  • azelaic acid
  • Benzoyl Peroxide
  • Clascoterone
  • Contraceptives, Oral, Combined
  • Cortodoxone
  • Dermatologic Agents
  • Dicarboxylic Acids
  • Doxycycline
  • Isotretinoin
  • Minocycline
  • Propionates
  • Retinoids
  • Salicylic Acid
  • sarecycline
  • Spironolactone
  • Tetracyclines