What are the Canadian clinical practice guidelines on the treatment of acne vulgaris?

Updated: Mar 26, 2019
  • Author: Jaggi Rao, MD, FRCPC; Chief Editor: William D James, MD  more...
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Answer

Canadian clinical practice guidelines for acne treatment have been updated; the following is a summary of their recommendations [76, 77] :

  • Comedonal acne - Topical retinoids or benzoyl peroxide; fixed-dose combinations adapalene–benzoyl peroxide and clindamycin–benzoyl peroxide; or the combination of clindamycin 1.2% and tretinoin 0.025% (as a gel); and, for women, consider combined oral contraceptives

  • Localized mild-to-moderate papulopustular acne - Benzoyl peroxide as monotherapy; topical retinoids as monotherapy; the fixed-dose combination of clindamycin 1% and benzoyl peroxide 5% and the fixed-dose combination of adapalene 0.1% and benzoyl peroxide 2.5% (as gels); or the combination of clindamycin 1.2% and tretinoin 0.025% gel

  • More extensive moderate papulopustular acne - Addition of systemic antibiotics to the topical medications above, as recommended for mild-to-moderate papulopustular acne

  • More extensive moderate papulopustular acne in women - Addition of combined oral contraceptives to the topical medications above, as recommended for mild-to-moderate papulopustular acne

  • Severe acne - Oral isotretinoin or systemic antibiotics in combination with benzoyl peroxide, with or without topical retinoids

  • Oral isotretinoin - Should only be prescribed by physicians with experience in prescribing and monitoring the drug; strict pregnancy precautions must be followed


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