Canadian Dermatologists Issue New Acne Treatment Guidelines

By Anne Harding

November 18, 2015

NEW YORK (Reuters Health) - Canadian researchers have published evidence-based guidelines to aid in treating acne, which affects up to 85% of adolescents and young adults.

"Unlike the prior Canadian acne treatment guidelines (2000), the present one is largely based on evidence from systematic analysis of acne treatments," corresponding author Dr. Jerry Tan of Western University in Windsor, Ontario, told Reuters Health by email. "The role of combination topical therapy is provided in greater detail in these guidelines compared to those released in 2000."

The updated guidelines are not substantially different from the European S3 guidelines, Dr. Tan added. "However, it is supplemented with our own analysis for interventions available in Canada but not in Europe."

Overall, in an article online November 16 in CMAJ, Dr. Tan and his team stated, "Acne should be treated early and effectively to mitigate adverse psychosocial impact, pigmentary alterations, and risk of scarring."

When choosing therapy for all categories of severity, the researchers stated, first line-therapy should be chosen based on:

* Previous therapies tried

* Patient skin type and the vehicle

* Practicality (location of acne, frequency of application)

* Cost

For comedonal acne the guidelines recommend topical benzoyl peroxide (BP), retinoids, or a combination of BP and topical retinoids or topical retinoids plus clindamycin. If monotherapy is not effective, according to the guidelines, consider fixed-dose clindamycin-tretinoin, and for women, combined oral contraceptives.

For localized mild-to-moderate papulopustular acne, the guidelines recommend topical BP, topical retinoids, and fixed-dose combinations. If acne is more extensive, they stated, add oral antibiotics or combined oral contraceptives (for women) to topical treatment.

For severe acne, oral isotretinoin is strongly recommended, but it should only be prescribed by physicians with experience in prescribing and monitoring the drug. "Strict pregnancy precautions must be followed," the guidelines state.

"These guidelines are based on the combination of both evidence and experience of the expert panel," Dr. Tan said.

"We have identified gaps in evidence including: uncertainties in durations for use of oral antibiotics to minimize development of antimicrobial-resistant bacteria (at cutanous and extracutaneous sites), and the lack of higher levels of evidence for often-used treatments, including fixed-dose erythromycin/tretinoin, spironolactone, and isotretinoin," Dr. Tan added.

Eight coauthors reported relevant relationships.


CMAJ 2015.