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MLT_GIB/OTH/0007/17m
Date of preparation: March 2018

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American Academy of Dermatology (AAD) Guidelines of care for the management of acne vulgaris (Updated 2016). 1

Monotherapy with topical antibiotics in the management of acne is not recommended because of the development of antibiotic resistance. 1

 

…the addition of BP [benzoyl peroxide] to regimens of antibiotic therapy enhances results and may reduce resistance development. 1

 

AAD Guidelines recommend combinations of topical antibiotics and benzoyl peroxide as a first line treatment in mild to moderate acne patients (Class A recommendation, Level I evidence) 1

  • Treatment algorithm [1]

    Treatment algorithm for the management of acne vulgaris in adolescents and young adults 1

      Mild Moderate Severe
    1st line treatment Benzoyl Peroxide (BP)
    or Topical Retinoid
    -or-
    Topical Combination Therapy*
    BP + Antibiotic or Retinoid + BP or Retinoid + BP + Antibiotic
    Topical Combination Therapy*
    BP + Antibiotic or Retinoid + BP or Retinoid + BP + Antibiotic
    -or-
    Oral Antibiotic + Topical Retinoid + BP
    -or-
    Oral Antibiotic + Topical Retinoid + BP + Topical Antibiotic
    Oral Antibiotic
    +
    Topical Combination Therapy*
    BP + Antibiotic or Retinoid + BP or Retinoid + BP + Antibiotic
    -or-
    Oral Isotretinoin
    Alternative treatment Add Topical Retinoid or BP (if not on already)
    -or-
    Consider Alternate Retinoid
    -or-
    Consider Topical Dapsone
    Consider Alternate Combination Therapy
    -or-
    Consider Change in Oral Antibiotic
    -or-
    Add Combined Oral Contraceptive or Oral Spironolactone (Females)
    -or-
    Consider Oral Isotretinoin
    Consider Change in Oral Antibiotic
    -or-
    Add Combined Oral Contraceptive or Oral Spironolactone (Females)
    -or-
    Consider Oral Isotretinoin

    *Indicates that the drug may be prescribed as a fixed combination product or as separate component

  • Strength of recommendations for the management and treatment of acne vulgaris [1]

    Topical antibiotics as monotherapy and fixed-dose combination of erythromycin and zinc are not recommended (i.e. have a negative recommendation) for the treatment of mild-to-moderate papulopustular acne. 1

     

  • Recommendations for topical therapies [1]

    Table V. Recommendations for topical therapies 1

    Benzoyl peroxide or combinations with erythromycin or clindamycin are effective acne treatments and are recommended as monotherapy for mild acne, or in conjunction with a topical retinoid, or systemic antibiotic therapy for moderate to severe acne
    Benzoyl peroxide is effective in the prevention of bacterial resistance and is recommended for patients on topical or systemic antibiotic therapy
    Topical antibiotics (eg, erythromycin and clindamycin) are effective acne treatments, but are not recommended as monotherapy because of the risk of bacterial resistance
    Topical retinoids are important in addressing the development and maintenance of acne and are recommended as monotherapy in primarily comedonal acne, or in combination with topical or oral antimicrobials in patients with mixed or primarily inflammatory acne lesions
    Using multiple topical agents that affect different aspects of acne pathogenesis can be useful. Combination therapy should be used in the majority of patients with acne
    Topical adapalene, tretinoin, and benzoyl peroxide can be safely used in the management of preadolescent acne in children
    Azelaic acid is a useful adjunctive acne treatment and is recommended in the treatment of postinflammatory dyspigmentation
    Topical dapsone 5% gel is recommended for inflammatory acne, particularly in adult females with acne
    There is limited evidence to support recommendations for sulfur, nicotinamide, resorcinol, sodium sulfacetamide, aluminium chloride, and zinc in the treatment of acne

View full AAD Guidelines

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Reference:

  1. Zaenglein AL et al. J Am Acad Dermatol 2016;74(5):945–973.e33.

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