Acne is one of the most common disorders treated by dermatologists and other health care providers. While it most often affects adolescents, it is not uncommon in adults and can also be seen in children. This evidence-based guideline addresses important clinical questions that arise in its management. Issues from grading of acne to the topical and systemic management of the disease are reviewed. Suggestions on use are provided based on available evidence.

https://www.jaad.org/article/S0190-9622(15)02614-6/pdf

Guidelines of care for the management of acne vulgaris

INTRODUCTION In the past 25 years, numerous topical and systemic drugs have been developed for the treatment of acne vulgaris The voluminous amount of clinical trial information has become increasingly difficult for individual physicians to monitor Clinical trials are a science no different than any other aspect of medicine There has been improvement in the design and performance of clinical trials in the past several years Currently, most authoritative opinions fully support the need for studies to be performed under the CONSORT and Cochrane principles We accept that many studies have not been as rigorously performed in the past as trials done in 2002 But to discard such studies is inappropriate, because they were done well according to the standards of the time Thus, for the time being, clinical opinion, based in part on formal discussion among expert colleagues with an interest in acne and a logical analysis of the literature, is not unreasonable as the basis for a Consensus Recommendation Such recommendations highlight the indications for use of medications and the optimal approach to the management of specific clinical problems Overall, the goal is to provide a comprehensive overview of rational therapy, which can form the basis for more uniform therapeutic strategies throughout the world, enhanced patient compliance, and more effective use of healthcare resources Several sets of guidelines have been developed for the treatment of acne during the past decade, including a practice guideline for the Oral Treatment of Acne in France (1999), Canadian Acne Treatment Guidelines (1995), German Guidelines for Acne Treatment (2001), Treatment of Acne Vulgaris: Guidelines for Primary Care Physicians (1991), and Guidelines of Care for Acne Vulgaris from the American Academy of Dermatology (1990) However, advances in medicine occur relatively rapidly, and practice guidelines may be out of date shortly after they are issued Thus, there is a continuing need to update existing recommendations so that recent advances in therapy can be brought to the attention of physicians in a timely manner In recognition of this need, this supplement to the Journal of the American Academy of Dermatology has been developed by a panel of physicians and researchers in the field of acne, working together as a Global Alliance to Improve Outcomes in Acne The mission of this group is to develop consensus recommendations for the treatment of acne, which are evidence-based when possible, and which include input from numerous countries The members of the group represent a broad list of international dermatologists with a special interest in acne and reflect a wide range of experiences and opinions The activities of the group have been coordinated by Dimensional Healthcare, Inc, and funded by an educational grant from Galderma As might be expected, some of the physicians involved in the development of this document have past or current, direct or indirect financial

https://www.jaad.org/article/S0190-9622(03)01563-9/pdf

Management of Acne: A Report From a Global Alliance to Improve Outcomes in Acne

Summary
Acne is estimated to affect 9·4% of the global population, making it the eighth most prevalent disease worldwide. Epidemiological studies have demonstrated that acne is most common in postpubescent teens, with boys most frequently affected, particularly with more severe forms of the disease. This paper aims to provide an update on the epidemiology of acne worldwide. Recent general and institutional studies from around the world have shown that the prevalence of acne is broadly consistent globally (with the exception of specific populations, which are discussed). However, this review highlights that there is a wide range of disparate outcome measures being applied in epidemiology studies, and we emphasize the need to develop a widely accepted, credible, standard assessment scale to address this in the future. In addition we discuss special populations, such as those devoid of acne, as well as the impact of potential determinants of acne on disease epidemiology.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/bjd.13462

A global perspective on the epidemiology of acne.

Disclaimer Adherence to these guidelines will not ensure successful treatment in every situation. Furthermore, these guidelines should not be deemed inclusive of all proper methods of care or exclusive of other methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific therapy must be made by the physician and the patient in light of all the circumstances presented by the individual patient.

https://www.huidziekten.nl/richtlijnen/AAD-guideline-acne-vulgaris-2007.pdf

Guidelines of care for acne vulgaris management.

The CLASI (Cutaneous Lupus Erythematosus Disease Area and Severity Index): An Outcome Instrument for Cutaneous Lupus Erythematosus

Background: This study examined the relationships of pubertal maturation and sex steroid hormones to the development of acne in young girls. Black (n=317) and white (n=306) premenarchal girls with a mean age of 9.97±0.62 years were evaluated for acne prevalence and severity, pubic hair and areolar maturation, and sex steroid hormone levels. Results: Overall, 77.8% of the girls had some acne; of the whole group, 48.3% had only comedonal acne, 2.2% had only inflammatory acne, and 27.3% had both types. Although black girls matured at an earlier age than white girls, racial differences in acne were minimal when adjusted for pubertal maturation. Acne increased with advancing maturation; at Tanner pubic hair stages 1, 2, and 3, the prevalence of acne rose from 73.1% to 84.0% and to 90.6%, respectively. Acne lesion counts at seven facial locations revealed a predominance of midfacial acne on the middle aspect of the forehead, nose, and chin. Sex steroid hormone levels measured in 365 of the girls were found to increase significantly during maturation from prepuberty to early puberty. Testosterone-estrogen—binding globulin and the ratio of testosterone to estradiol decreased. In 118 prepubertal girls, estradiol, total and free testosterone, progesterone, testosterone to estradiol ratio, and testosterone-estrogen—bindingglobulin levels were no different whether in subjects with acne or without acne. However, the level of dehydroepiandrosterone sulfate, an androgen of adrenal origin, was significantly higher in prepubertal girls with acne. Conclusion: Acne, especially the comedonal type, can be the first sign of pubertal maturation in girls, even preceding pubic hair and areolar development. Concentration of dehydroepiandrosterone sulfate is significantly and specifically associated with the initiation of acne in young girls. (Arch Dermatol. 1994;130:308-314)

https://jamanetwork.com/journals/DERM/articlepdf/555640/archderm_130_3_006.pdf

Acne Vulgaris in Premenarchal Girls: An Early Sign of Puberty Associated With Rising Levels of Dehydroepiandrosterone

Background: Despite widespread use of acne lesion counting, little has been published on its reliability, particularly for multiple raters. Objective: Our purpose was to assess reliability of acne lesion counting with the use of a five-segment facial template. Methods: After training, 12 raters each evaluated 12 patients in randomized order, in the morning and again in the afternoon, and recorded counts for different types of lesions on a five-segment facial template. Results: Individual raters could reproduce their total lesion counts (reliability estimates, 0.81 to 0.97). Variability between raters was high, and overall reliability estimated across raters was 0.61. For a subgroup of commonly trained raters, overall reliability was higher (0.80). Conclusion: The reliability of acne lesion counting is excellent when performed by the same trained rater over time. The high variability between raters appears to be reduced by standardized training. Because fewer lesions are counted with less variation, use of a template may have contributed to the high within-rater reliability.

A multirater validation study to assess the reliability of acne lesion counting

Acne Vulgaris in Premenarchal Girls

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Acne Vulgaris in Premenarchal Girls: An Early Sign of Puberty Associated With Rising Levels of Dehydroepiandrosterone

A multirater validation study to assess the reliability of acne lesion counting

Acne Vulgaris in Premenarchal Girls