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European Dermatology Forum (EDF) S3-Guideline for the treatment of acne (Updated 2016) 1
“The use of topical and systemic antibiotics should be optimized by using appropriate combinations for a predefined duration, in order to reduce the development of antibiotic resistance.” 1
“Due to the serious concerns regarding the risk of developing antibiotic resistance, topical monotherapy with antibiotics is generally not recommended.” 1
The EDF Guidelines give the highest recommendation for fixed-dose combinations of benzoyl peroxide (BPO) + clindamycin (Duac) or BPO + adapalene as first-line therapy in mild to moderate papulopustular acne 1
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Assessing patients and choice of treatment (1)
The EDF Guideline recommends that the correct choice of therapy should be facilitated by presenting the suitable therapy options in a therapy algorithm, taking into account the type of acne and the severity of disease. 1
“The use of Quality of Life (QoL) measures captures the impact of acne as well as the impact of treatment on the patient’s life, and as a result supports identification of those vulnerable to psychological complications. Adopting a QoL measure as an integral part of acne management is recommended.” 1
Classification of acne
In order to give treatment recommendations based on disease activity, the EU Guideline group has used the following simple clinical classification: 1
- Comedonal acne
- Mild - moderate papulopustular acne
- Severe papulopustular acne, moderate nodular acne
- Severe nodular acne, conglobate acne
See more information about assessing and classifying acne, including patient images
Find out more about the treatment recommendations below.
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Recommendations for comedonal acne (1)
High strength recommendation
None
Medium strength recommendation
- Topical retinoids
Low strength recommendation
- Benzoyl peroxide
- Azelaic acid
Not recommended
- Topical antibiotics
- Hormonal antiandrogens
- Systemic antibiotics
- Systemic isotretinoin
- Artificial ultraviolet (UV) radiation
Open recommendation
A recommendation for or against treatment of comedonal acne with visible light as monotherapy, lasers with visible wavelengths and lasers with infrared wavelengths, with intense pulsed light (IPL) and photodynamic therapy (PDT) cannot be made at the present time.
Negative recommendation
Topical antibiotics are not recommended for the treatment of comedonal acne.
Hormonal antiandrogens, systemic antibiotics and/ or systemic isotretinoin are not recommended for the treatment of comedonal acne.
Artificial ultraviolet (UV) radiation is not recommended for the treatment of comedonal acne. -
Recommendations for mild-to-moderate papulopustular acne (1)
High strength recommendation
- Fixed-dose combination of benzoyl peroxide and clindamycin or adapalene
Medium strength recommendation
- Benzoyl peroxide
- Azelaic acid
- Topical retinoids
- Combination of a systemic antibiotic with adapalene
- Fixed-dose combination clindamycin and tretinoin
Low strength recommendation
- A combination of a systemic antibiotic with adapalene in fixed-dose combination with benzoyl peroxide or benzoyl peroxide or azelaic acid
- Fixed-dose combination of erythromycin and tretinoin or isotretinoin
- Blue light monotherapy
- Oral zinc
Not recommended
- Topical antibiotics as monotherapy
- Artificial UV radiation
- The fixed-dose combination of erythromycin and zinc
- Systemic therapy with anti-androgens, antibiotics, and/ or isotretinoin
Open recommendation
Due to a lack of sufficient evidence, a recommendation for or against treatment of mild to moderate papulopustular acne with red light, IPL, Laser or PDT cannot be made at the present time
Negative recommendation
Topical antibiotics as monotherapy are not recommended for the treatment of mild to moderate papulopustular acne.
Artificial UV radiation is not recommended for the treatment of mild to moderate papulopustular acne.
The fixed-dose combination of erythromycin and zinc is not recommended for the treatment of mild to moderate papulopustular acne.
Systemic therapy with anti-androgens, antibiotics, and/ or isotretinoin is not recommended for the treatment of mild to moderate papulopustular acne. -
Recommendations for severe papulopustular acne – moderate nodular acne (1)
High strength recommendation
- Oral isotretinoin monotherapy
Medium strength recommendation
- Combination of a systemic antibiotic with fixed-dose combination of benzoyl peroxide and adapalene.
- Combination of a systemic antibiotic with adapalene or azelaic acid
Low strength recommendation
- Combination of a systemic antibiotic with benzoyl peroxide
- Females only:
- Hormonal antiandrogens in combination with systemic antibiotics and/or topicals (apart from antibiotics)
- Hormonal antiandrogens in combination with systemic antibiotics and/or topicals (apart from antibiotics)
Not recommended
- Single or combined topical monotherapy
- Oral antibiotics or anti-androgens as monotherapy
- Visible light as monotherapy
- Artificial UV radiation sources
Open recommendation
Due to a lack of sufficient evidence, a recommendation for or against treatment of severe papulopustular/moderate nodular acne with red light, IPL, Laser or PDT cannot be made at the present time. Although PDT is effective a recommendation for or against its use cannot be made due to a lack of standard treatment regimens that ensure a favourable profile of acute adverse reaction.
Negative recommendation
Single or combined topical monotherapy is not recommended for the treatment of severe papulopustular/ moderate nodular acne.
Oral antibiotics as monotherapy are not recommended for the treatment of severe papulopustular/ moderate nodular acne.
Oral anti-androgens as monotherapy are not recommended for the treatment of severe papulopustular/ moderate nodular acne.
Visible light as monotherapy is not recommended for the treatment of severe papulopustular/ moderate nodular acne.
Artificial UV radiation sources are not recommended as a treatment of severe papulopustular/ moderate nodular acne. -
Recommendations for severe nodular\conglobate acne (1)
High strength recommendation
- Oral isotretinoin monotherapy
Medium strength recommendation
- Combination of a systemic antibiotic with fixed-dose combination of benzoyl peroxide and adapalene
- Combination of a systemic antibiotic with azelaic acid
Low strength recommendation
- Combination of a systemic antibiotic with benzoyl peroxide or adapalene
- Females only:
- Hormonal antiandrogens in combination with systemic antibiotics and/or topicals (apart from antibiotics)
- Hormonal antiandrogens in combination with systemic antibiotics and/or topicals (apart from antibiotics)
Not recommended
- Topical monotherapy
- Oral antibiotics or anti-androgens
- Artificial UV radiation sources
- Visible light as monotherapy
Open recommendation
Due to a lack of sufficient evidence, it is currently not possible to make a recommendation for or against treatment with IPL or laser in severe nodular/ conglobate acne. Although PDT is effective it cannot yet be recommended due to a lack of standard treatment regimens that ensure a favourable profile of acute adverse reaction.
Negative recommendation
Topical monotherapy is not recommended for the treatment of conglobate acne.
Oral antibiotics are not recommended as monotherapy for the treatment of severe nodular/ conglobate acne.
Oral anti-androgens are not recommended as monotherapy for the treatment of severe nodular/ conglobate acne.
Artificial UV radiation sources are not recommended for the treatment of severe nodular/ conglobate acne.
Visible light as monotherapy is not recommended for the treatment of severe nodular/ conglobate acne.
Why choose Duac? View efficacy and tolerability data vs Epiduo (adapalene/BPO)
Find out how the two components in Duac work together to reduce the risk of antibiotic resistance
Reference:
- Nast A et al. European Dermatology Forum. S3-Guideline for the treatment of acne (Update 2016). Available at: http://www.euroderm.org/edf/index.php/edf-guidelines/category/4-guidelines-acne (Accessed March 2017).
