H P Gollnick1, V Bettoli2, J Lambert3, E Araviiskaia4, I Binic5, C Dessinioti6, I Galadari7, R Ganceviciene8, N Ilter9, M Kaegi10, L Kemeny11, J L López-Estebaranz12, A Massa13, C Oprica14,15, W Sinclair16, J C Szepietowski17, B Dréno18. 1. Department of Dermatology & Venereology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany. 2. Department of Clinical and Experimental Medicine, O.U. of Dermatology, Azienda Ospedaliero-Universitaria, University of Ferrara, Ferrara, Italy. 3. Department of Dermatology, University Hospital of Antwerp, University of Antwerp, Edegem, Belgium. 4. Department of Dermatology and Venereal Diseases, First I. P. Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia. 5. Department of Dermatovenerology, Faculty of Medicine, University of Nis, Nis, Serbia. 6. Department of Dermatology, A. Syggros Hospital, University of Athens, Athens, Greece. 7. School of Medicine, United Arab Emirates University, Al-Ain, United Arab Emirates. 8. Clinic of Infectious, Chest Diseases, Dermatovenereology and Allergology, Vilnius University, Vilnius, Lithuania. 9. Department of Dermatology, Gazi University Medical School, Ankara, Turkey. 10. Hautzentrum Zürich, Zürich, Switzerland. 11. Department of Dermatology and Allergology University of Szeged, Szeged, Hungary. 12. Hospital Universitario Fundación Alcorcón, Madrid, Spain. 13. Clínica Dermatológica Dr António Massa, Porto, Portugal. 14. Department of Laboratory Medicine, Karolinska Institutet Karolinska University Hospital Huddinge, Stockholm, Sweden. 15. Diagnostiskt Centrum Hud, Stockholm, Sweden. 16. Department of Dermatology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa. 17. Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland. 18. Department of Dermato-Cancerology, University of Nantes, Nantes, France.
Abstract
BACKGROUND: Many current guidelines provide detailed evidence-based recommendations for acne treatment. OBJECTIVE: To create consensus-based, simple, easy-to-use algorithms for clinical acne treatment in daily office-based practice and to provide checklists to assist in determining why a patient may not have responded to treatment and what action to take. METHODS: Existing treatment guidelines and consensus papers were reviewed. The information in them was extracted and simplified according to daily clinical practice needs using a consensus-based approach and based on the authors' clinical expertise. RESULTS: As outcomes, separate simple algorithms are presented for the treatment of predominant comedonal, predominant papulopustular and nodular/conglobate acne. Patients with predominant comedonal acne should initially be treated with a topical retinoid, azelaic acid or salicylic acid. Fixed combination topicals are recommended for patients with predominant papulopustular acne with treatment tailored according to the severity of disease. Treatment recommendations for nodular/conglobate acne include oral isotretinoin or fixed combinations plus oral antibiotics in men, and these options may be supplemented with oral anti-androgenic hormonal therapy in women. Further decisions regarding treatment responses should be evaluated 8 weeks after treatment initiation in patients with predominant comedonal or papulopustular acne and 12 weeks after in those with nodular/conglobate acne. Maintenance therapy with a topical retinoid or azelaic acid should be commenced once a patient is clear or almost clear of their acne to prevent the disease from recurring. The principal explanations for lack of treatment response fall into 5 main categories: disease progression, non-drug-related reasons, drug-related reasons, poor adherence, and adverse events. CONCLUSION: This practical guide provides dermatologists with treatment algorithms adapted to different clinical features of acne which are simple and easy to use in daily clinical practice. The checklists to establish the causes for a lack of treatment response and subsequent action to take will facilitate successful acne management.
BACKGROUND: Many current guidelines provide detailed evidence-based recommendations for acne treatment. OBJECTIVE: To create consensus-based, simple, easy-to-use algorithms for clinical acne treatment in daily office-based practice and to provide checklists to assist in determining why a patient may not have responded to treatment and what action to take. METHODS: Existing treatment guidelines and consensus papers were reviewed. The information in them was extracted and simplified according to daily clinical practice needs using a consensus-based approach and based on the authors' clinical expertise. RESULTS: As outcomes, separate simple algorithms are presented for the treatment of predominant comedonal, predominant papulopustular and nodular/conglobate acne. Patients with predominant comedonal acne should initially be treated with a topical retinoid, azelaic acid or salicylic acid. Fixed combination topicals are recommended for patients with predominant papulopustular acne with treatment tailored according to the severity of disease. Treatment recommendations for nodular/conglobate acne include oral isotretinoin or fixed combinations plus oral antibiotics in men, and these options may be supplemented with oral anti-androgenic hormonal therapy in women. Further decisions regarding treatment responses should be evaluated 8 weeks after treatment initiation in patients with predominant comedonal or papulopustular acne and 12 weeks after in those with nodular/conglobate acne. Maintenance therapy with a topical retinoid or azelaic acid should be commenced once a patient is clear or almost clear of their acne to prevent the disease from recurring. The principal explanations for lack of treatment response fall into 5 main categories: disease progression, non-drug-related reasons, drug-related reasons, poor adherence, and adverse events. CONCLUSION: This practical guide provides dermatologists with treatment algorithms adapted to different clinical features of acne which are simple and easy to use in daily clinical practice. The checklists to establish the causes for a lack of treatment response and subsequent action to take will facilitate successful acne management.
Authors: Alison M Layton; E Anne Eady; Heather Whitehouse; James Q Del Rosso; Zbys Fedorowicz; Esther J van Zuuren Journal: Am J Clin Dermatol Date: 2017-04 Impact factor: 7.403
Authors: Caroline S Costa; Ediléia Bagatin; Ana Luiza C Martimbianco; Edina Mk da Silva; Marília M Lúcio; Parker Magin; Rachel Riera Journal: Cochrane Database Syst Rev Date: 2018-11-24
Authors: Brigitte Dréno; Robert Bissonnette; Angélique Gagné-Henley; Benjamin Barankin; Charles Lynde; Nabil Kerrouche; Jerry Tan Journal: Am J Clin Dermatol Date: 2018-04 Impact factor: 7.403