Acne Vulgaris: Treatment Guidelines from the AAD
Am Fam Physician. 2017 Jun 1;95(11):740-741.
Author disclosure: No relevant financial affiliations.
Key Points for Practice
• First-line treatment for mild acne vulgaris includes benzoyl peroxide or a topical retinoid, or a combination of topical medications including topical antibiotics.
• Tetracyclines are the preferred oral antibiotic, and doxycycline and minocycline have been shown to be more effective than tetracycline.
• Topical or oral antibiotics should not be used as monotherapy because of the risk of developing resistance.
From the AFP Editors
Acne vulgaris, which occurs in 50 million persons living in the United States, is associated with physical and psychological morbidity (e.g., scarring, poor self-image, depression) and results in more than $3 billion in direct costs annually. In addition, knowledge about its pathogenesis is constantly evolving. The American Academy of Dermatology (AAD) has released guidelines for managing acne vulgaris in adolescents and adults.
First-line and Alternative Treatment Options
First-line treatment for mild acne vulgaris includes benzoyl peroxide or a topical retinoid, or a combination of topical medications consisting of benzoyl peroxide and an antibiotic (erythromycin or clindamycin), retinoid, or both. An alternative treatment would include the addition of a topical retinoid or benzoyl peroxide if not already prescribed; a different retinoid; or topical dapsone (Aczone).
First-line treatment for moderate acne vulgaris includes a combination of benzoyl peroxide and a topical antibiotic (erythromycin or clindamycin), topical retinoid, or both; benzoyl peroxide, an oral antibiotic, and topical retinoid; or benzoyl peroxide, oral and topical antibiotics, and a topical retinoid. Alternative treatments to be considered include a different combination of medications; changing the oral antibiotic; adding a combined oral contraceptive or spironolactone in females; or oral isotretinoin.
First-line treatment for severe acne vulgaris includes an oral antibiotic, benzoyl peroxide, and a topical antibiotic (erythromycin or clarithromycin),
Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.
This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.
A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide.
Copyright © 2017 by the American Academy of Family Physicians.
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