2024 AAD Updated Acne Treatment Guidelines

Overview

• Presenter: Dr. Cassal
• Topic: Review of updated treatment guidelines for acne by the American Academy of Dermatology (AAD) for 2024
• Focus: Separate guidelines based on acne severity: mild and moderate to severe.

Mild Acne Treatment

Mainstay Treatments

• Topical Therapies (Strongly recommended):
  • Topical Retinoids
  • Benzoyl Peroxide
  • Topical Antibiotics
    • Note: Should not be used as monotherapy to avoid antibiotic resistance.
    • Can be combined (e.g., Clindamycin with Benzoyl Peroxide - "Benzaclin").
  • Combination Therapy: Often involves topical retinoids and salicylic acid washes.

Conditionally Recommended Treatments

• Clascoterone (Winlevi):
  • Topical androgen receptor blocker.
  • Mixed patient feedback on effectiveness.
• Salicylic Acid:
  • Lipophilic, penetrates pores, used as wash or leave-on product.
  • Preferred treatment, often combined with retinoids.
• Azelaic Acid:
  • Effective for sensitive skin and post-inflammatory hyperpigmentation.
  • Safe during pregnancy.
  • Available over-the-counter (e.g., The Ordinary, Naturium).

Moderate to Severe Acne Treatment

Systemic Antibiotics

• Doxycycline:
  • Strongly recommended.
  • Decreases bacteria and inflammation.
  • Causes sun sensitivity and stomach upset.
• Conditionally Recommended Antibiotics:
  • Minocycline: Less preferred due to potential side effects (e.g., pigmentation changes).
  • Sarecycline: Newer tetracycline option.
  • Erythromycin: Alternative for doxycycline intolerant patients.

Hormonal Agents

• Combined Oral Contraceptives:
  • Stabilize hormone levels, reducing acne.
• Spironolactone:
  • Potassium-sparing diuretic that blocks androgen receptors.
  • Useful for hormonal acne.

Other Treatments

• Intralesional Corticosteroids:
  • Used for large acne lesions to reduce inflammation.
  • Requires skilled administration to prevent scarring.
• Isotretinoin (Accutane):
  • Vitamin A derivative for severe acne.
  • Reduces oil production, inflammation, and bacteria colonization.
  • Promotes normal skin cell growth.
  • Requires dermatologist supervision for safety.

Conclusion

• Recommendation: Follow these guidelines for acne treatment based on severity.
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