The Canadian Medical Association Journal (CMAJ) recently released a new Canadian clinical practice guideline for treating acne in children and adults. The guideline, published online on Nov. 16, 2015 in CMAJ, updates the previous guidance published 15 years ago.
Highlights from the report for the treatment of the three acne presentations include:
For comedonal acne—topical benzoyl peroxide, retinoids or a combination of topical retinoids with benzoyl peroxide or clindamycin is recommended. If a single therapy does not work, use of fixed-dose clindamycin-tretinoin may be considered, and in women, combined oral contraceptives.
For localized mild-to-moderate papulopustular acne—topical benzoyl peroxide is recommended. There is also strong evidence for use of topical retinoids and fixed-dose combinations. For more extensive moderate papulopustular acne, oral antibiotics or combined oral contraceptives (in women) with the above topical treatments are recommended.
For severe acne—use of oral isotretinoin is strongly recommended, although only physicians with experience in prescribing and monitoring the drug should prescribe. Strict pregnancy preventive measures must be followed.
"We hope that these guidelines will help health care professionals address the common scourge of acne in patients of various ages," states Dr. Jerry Tan in a press release.
"With early diagnosis, treatment of active lesions and prevention of adverse potential sequelae (e.g., scarring, dyspigmentation and psychosocial impact), the health of the many Canadians with acne may be improved," writes Dr. Jerry Tan, Department of Medicine, Western University in London, Ont., with coauthors.
The other dermatologists involved in creating this acne treatment guideline include Drs. Yuka Asai, Akerke Baibergenova, Maha Dutil, Shannon Humphrey, Peter Hull, Charles Lynde, Yves Poulin, Neil Shear, John Toole and Catherine Zip.
During the creation of the guideline, the team of dermatologists reviewed the latest evidence and provided treatment recommendations for three acne presentations including comedonal acne; mild-to-moderate papulopustular acne; and severe inflammatory acne. The guideline developers did not include neonatal or infant acne, late-onset acne, acne rosacea and other variant forms.
Since provincial healthcare plans do not cover many of the recommended therapies, the authors state that cost to patients should be a factor in deciding treatment.