New Acne Treatment Guidelines Emphasize Psychological Effects

Since acne is a chronic disease capable of causing serious psychological and social problems, it warrants early, aggressive treatment and prolonged maintenance therapy, according to updated treatment guidelines.

The guidelines encourage physicians to view acne as a potentially life-altering disorder, not simply a passing irritant of puberty. “Many of our medical colleagues and a significant proportion of the lay public dismiss acne as a natural part of growing up that has few real consequences,” wrote Dr. Diane Thiboutot and her colleagues. “Yet considerable evidence shows that acne can be a psychologically damaging condition that lasts for years” (J. Am. Acad. Dermatol. 2009;60:S1-50).

The Global Alliance to Improve Outcomes in Acne published the document as an update to its 2003 guidelines. The new recommendations draw on a large body of new evidence that was not available then, according to Dr. Thiboutot of Pennsylvania State University, Hershey, and her coauthors. “This edition includes updates on pathophysiology and treatment … such as lasers and light therapy … combination therapy, revision of acne scarring, and maintenance therapy.”

The role of antibiotics is changing in acne, mostly due to emerging concerns about antibiotic resistance. Overuse of antibiotics can lead to resistant forms of Propionibacterium acnes, which manifest a reduced or absent response and relapse. These resistant forms can even be spread to household contacts, new studies suggest.

To minimize resistance, the guidelines recommend that acne therapy consist of a combination of a topical retinoid with an antimicrobial (oral or topical). If an antibiotic is necessary, it should be of limited duration and combined with benzoyl peroxide, which has been shown to reduce the emergence of antibiotic-resistant P. acnes.

New research suggests that laser and light therapy may play an increasing role in acne treatment, although their routine use cannot yet be justified, the authors noted. Light-based treatments aim to reduce P. acnes levels and disrupt sebaceous gland function; lights also may have an anti-inflammatory action. The optimal strategies, frequencies, and device settings, however, must be clarified with further studies before light-based treatments can become fully integrated into the acne armamentarium.

In addition to being part of the first-line treatment, topical retinoids should be the backbone of acne maintenance therapy. The compounds prevent the formation of comedones and inflammatory lesions and carry no known additional safety issues with long-term use. Both adapalene and tazarotene have been shown effective as maintenance agents, with good to excellent tolerability.

Long-term maintenance therapy with antibiotics is not recommended; benzoyl peroxide may be added to a long-term retinoid regimen to provide antimicrobial action, the guidelines suggest.

Since acne is a chronic disease capable of causing serious psychological and social problems, it warrants early, aggressive treatment and prolonged maintenance therapy, according to updated treatment guidelines.

The guidelines encourage physicians to view acne as a potentially life-altering disorder, not simply a passing irritant of puberty. “Many of our medical colleagues and a significant proportion of the lay public dismiss acne as a natural part of growing up that has few real consequences,” wrote Dr. Diane Thiboutot and her colleagues. “Yet considerable evidence shows that acne can be a psychologically damaging condition that lasts for years” (J. Am. Acad. Dermatol. 2009;60:S1-50).

The Global Alliance to Improve Outcomes in Acne published the document as an update to its 2003 guidelines. The new recommendations draw on a large body of new evidence that was not available then, according to Dr. Thiboutot of Pennsylvania State University, Hershey, and her coauthors. “This edition includes updates on pathophysiology and treatment … such as lasers and light therapy … combination therapy, revision of acne scarring, and maintenance therapy.”

The role of antibiotics is changing in acne, mostly due to emerging concerns about antibiotic resistance. Overuse of antibiotics can lead to resistant forms of Propionibacterium acnes, which manifest a reduced or absent response and relapse. These resistant forms can even be spread to household contacts, new studies suggest.

To minimize resistance, the guidelines recommend that acne therapy consist of a combination of a topical retinoid with an antimicrobial (oral or topical). If an antibiotic is necessary, it should be of limited duration and combined with benzoyl peroxide, which has been shown to reduce the emergence of antibiotic-resistant P. acnes.

New research suggests that laser and light therapy may play an increasing role in acne treatment, although their routine use cannot yet be justified, the authors noted. Light-based treatments aim to reduce P. acnes levels and disrupt sebaceous gland function; lights also may have an anti-inflammatory action. The optimal strategies, frequencies, and device settings, however, must be clarified with further studies before light-based treatments can become fully integrated into the acne armamentarium.

In addition to being part of the first-line treatment, topical retinoids should be the backbone of acne maintenance therapy. The compounds prevent the formation of comedones and inflammatory lesions and carry no known additional safety issues with long-term use. Both adapalene and tazarotene have been shown effective as maintenance agents, with good to excellent tolerability.

Long-term maintenance therapy with antibiotics is not recommended; benzoyl peroxide may be added to a long-term retinoid regimen to provide antimicrobial action, the guidelines suggest.

Since acne is a chronic disease capable of causing serious psychological and social problems, it warrants early, aggressive treatment and prolonged maintenance therapy, according to updated treatment guidelines.

The guidelines encourage physicians to view acne as a potentially life-altering disorder, not simply a passing irritant of puberty. “Many of our medical colleagues and a significant proportion of the lay public dismiss acne as a natural part of growing up that has few real consequences,” wrote Dr. Diane Thiboutot and her colleagues. “Yet considerable evidence shows that acne can be a psychologically damaging condition that lasts for years” (J. Am. Acad. Dermatol. 2009;60:S1-50).

The Global Alliance to Improve Outcomes in Acne published the document as an update to its 2003 guidelines. The new recommendations draw on a large body of new evidence that was not available then, according to Dr. Thiboutot of Pennsylvania State University, Hershey, and her coauthors. “This edition includes updates on pathophysiology and treatment … such as lasers and light therapy … combination therapy, revision of acne scarring, and maintenance therapy.”

The role of antibiotics is changing in acne, mostly due to emerging concerns about antibiotic resistance. Overuse of antibiotics can lead to resistant forms of Propionibacterium acnes, which manifest a reduced or absent response and relapse. These resistant forms can even be spread to household contacts, new studies suggest.

To minimize resistance, the guidelines recommend that acne therapy consist of a combination of a topical retinoid with an antimicrobial (oral or topical). If an antibiotic is necessary, it should be of limited duration and combined with benzoyl peroxide, which has been shown to reduce the emergence of antibiotic-resistant P. acnes.

New research suggests that laser and light therapy may play an increasing role in acne treatment, although their routine use cannot yet be justified, the authors noted. Light-based treatments aim to reduce P. acnes levels and disrupt sebaceous gland function; lights also may have an anti-inflammatory action. The optimal strategies, frequencies, and device settings, however, must be clarified with further studies before light-based treatments can become fully integrated into the acne armamentarium.

In addition to being part of the first-line treatment, topical retinoids should be the backbone of acne maintenance therapy. The compounds prevent the formation of comedones and inflammatory lesions and carry no known additional safety issues with long-term use. Both adapalene and tazarotene have been shown effective as maintenance agents, with good to excellent tolerability.

Long-term maintenance therapy with antibiotics is not recommended; benzoyl peroxide may be added to a long-term retinoid regimen to provide antimicrobial action, the guidelines suggest.