Reynolds RV et al.
- March 2024 - Journal American Academy Dermatology – doi.org/10.1016.jaad.2023.12.017
This is an update of the guidelines already proposed by the American Academy of Dermatology in 2016.
Strong recommendations for the use of Benzoyl Peroxide 5 and 3 %, retinoids (adapalene, tazarotene and trifarotene, tretinoin) to be applied only in the evening because of the risk of photosensitization reactions, tropic antibiotics (erithromycin, clindamycin, minocycline and dapsone), never to be used as monotherapy.
Among systemic antibiotics, although minocycline is considered more effective but not without serious if rare side effects, oral doxycycline is indicated as the first use, even at low dosage (20 mg twice daily or 40 mg daily) for no more than 3-4 months and not as monotherapy but in combination with topical benzoylperoxide in order to reduce the risk of antibiotic resistance.
Oral isotretinoin (0.5-0.7 mg/kg die) is strongly recommended for severe, potentially scarring acne, in cases of impaired quality of life and psychosocial repercussions, and for all forms of acne where standard topical or systemic treatments have proven ineffective. Control examinations of little relevance but still recommended liver function and lipid control.
In females, recommended use of estroprogestin with antiandrogenic action and spironolactone (50-200 mg/day).
