what's up you guys it's Dr cassal today I want to review the 2024 American Academy of Dermatology updated treatment guidelines for acne it's been a little while since they've updated this treatment algorithm so let's dive into it together and see if there are any major changes so they've subdivided this treatment algorithm based on severity so you have mild acne in one category and moderat to severe acne in another category we'll talk about the mild first and then we'll go into moderate to severe the main state of treatment for mild acne is topical therapies and these are graded based on the level of evidence to support their use so in the strong recommend category no big surprise here we have topical retinoids benzo peroxide and topical antibiotics it's recommended that topical antibiotics are not prescribed as monotherapy meaning by themselves because this can contribute to antibiotic resistance if used over time so if any of those agents aren't working on their own you can combine them together so you could use for example like topical clinty with benzol peroxide there's a drug called benzaclin that's commonly used that's a combination of both of those together you can also use topical retinoids of benzol peroxide but I find this to be particularly harsh in a lot of patients and so for that reason I'll typically recommend like a salicylic acid wash with a topical retinoid then possibly adding on a topical antibiotic next on the list we have the conditionally recommended treatments so these are not the strongly recommended treatments mentioned above these are conditionally recommended and these include the following class cotone salicylic acid and AIC acid so clascoterone this goes by the name wind Levy it's an topical Androgen receptor blocker so basically what it does is Androgen in circulation from binding to sebaceous glands in the skin and causing the development of acne in the skin even though the data for it is pretty good I haven't had many patients that have been on it come back and say this has been like life-changing for them maybe other dermatologists have had different experiences but I haven't found it to be extremely useful thus far next we have salicylic acid salicylic acid is one of my favored ingredients it's a lipophilic acid meaning that it's fat loving and can penetrate down deep into the pores and help to clear pores in a phenomenal way it can be used as a wash or a leon product both of which work phenomenally well and I'll often times combine salicylic acid wash with a topical retinoid for mild acne that's usually my go-to treatment and you don't have to worry about benzol peroxide bleaching all of your towels and sheets and pill cases last but not least we have aoic acid on this list do not sleep on AIC acid it's a phenomenal ingredient it's gentle enough to use on sensitive skin so if you have rosacea you can use aoic acid it's great for acne and it's awesome for post-inflammatory hyperpigmentation so if you're treating acne in skin of color you could treat both the acne and the hyperpigmentation with AIC acid and it's one of the only treatments that we use for acne that's safe use when you're pregnant so huge plus there there is one brand called dermatica that makes a 20% over-the-counter aoic acid if not 20% is available by prescription I believe the name is aelex and there are other over-the-counter ones that are pretty good the ordinary makes a good one naturium and paulish choice I believe all make solid AIC acid products next we're going to kind of transition let's talk about the moderate to severe treatment of acne this is broken out to categories as well so we have systemic antibiotics hormonal agents and isotret know him okay so let's talk about systemic antibiotics first so no shocker here the most strongly recommended antibiotic by the aad is doxy cyclin good old vitamin D as we refer to in dermatology doxy cycl is a phenomenal medication to treat acne it kills the acne causing bacteria and helps to decrease inflammation all in one fail swoop the things to remember about doxycyclin is that it causes sensitivity to the Sun so you really have to stay out of the sun while you're on it and always take it with food cuz it could cause a really bad upset stomach that's the only strongly recommended antibiotic the conditionally recommend and antibiotics are mainly other tetracyclin in the same family so minocyclin is another one that's used it's not used as often because it can cause pigment abnormalities and a couple other autoimmune diseases so we typically don't like minocyclin over doxycycl for that exact reason another conditionally recommended antibiotic is sahy which is a newer generation tetracyclin and then the last thing on this list it says doxycycl is preferred over aiyin so some patients can't take doxycyclin because they're allergic to it or for whatever other reason and in that case sometimes we'll use AI M dosed about every other day doxycyclin is still preferred but if they can't take doxycyclin aiyin is an option next we have hormonal agents this includes combined oral contraceptives or birth control pills and how these work is basically if you look at a graph and the x-axis is days of the month and the y- axis is hormones you'll see the normal fluctuation of hormone levels throughout the month which correlate with acne severity when you have increased androgens floating in the bloodstream they can bind to The receptors in the skin and cause the formation of acne pimples oral contraceptive pills to help to Flatline hormone levels which prevents the development of acne in people who are prone to hormonal acne next in this category is spironolactone spironolactone was developed as a potassium sparing diuretic for the treatment of blood pressure and they found out later on that it actually blocks the Androgen receptors just like class odone that I've mentioned previously so for that reason spironolactone can be particularly helpful in people who are predisposed to hormonal acne the biggest things to watch out for are possible changes in your blood pressure next in this category is interlesional corticosteroids so corticosteroids we use a bunch of in dermatology they're potent potent anti-inflammatory compounds and for moderate to severe acne if you have a large acne lesion we can actually inject the acne lesion with corticosteroids and that's going to help to decrease inflammation and help it to shrink up a lot quicker caveat here being make sure if you have this done whoever is doing it is very very highly trained in this if done improperly it can cause permanent scarring it can cause atrophy of fat underneath the skin and pigment changes last but not least in our categories we have isotron or Accutane this is a vitamin a derivative it works phenomenally well for the treatment of severe acne and can even help improve and prevent further acne scarring isot trat known is a phenomenal and safe medication when used correctly always always always see your dermatologist if this is something that you want to discuss it basically targets everything that causes acne so it decreases oil production in the skin decreases skin inflammation decreases colonization with acne causing bacteria and it helps the skin cells to grow normally like topical retinoids do so ISO Tren noan is awesome hopefully you guys found this video helpful if you did be sure to like comment and subscribe let me know what skincare or Dermatology topics that you want to see and I'll do my best to cover them thank you guys