Table of contents
Acne vulgaris
What's new
Updated 2024 AAD guidelines for the management of acne vulgaris.
Background
Overview
Definition
Acne vulgaris is a chronic inflammatory skin condition that predominantly affects late adolescents and young adults.
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Pathophysiology
The pathophysiology of acne vulgaris is multifaceted, which includes disturbed sebaceous gland activity leading to hyperseborrhea or increased sebum production, dysregulation of the hormone microenvironment, interaction with neuropeptides, follicular hyperkeratinization, induction of inflammation, and dysfunction of the innate and adaptive immunity.
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Epidemiology
The worldwide prevalence of acne vulgaris is estimated at 1,585 per 100,000 population.
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Disease course
Clinically, acne vulgaris presents with a variety of lesions, including open and closed comedones (blackheads and whiteheads), inflammatory papules, pustules, and nodules and cysts in severe cases. It typically resolves in the late teens or early adulthood, but for some patients, it can persist into later life. Scarring, a potential consequence, can reduce the QoL of patients.
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Prognosis and risk of recurrence
Acne vulgaris is not a life-threatening condition. However, it can have significant physical and psychological effects.
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Guidelines
Key sources
The following summarized guidelines for the evaluation and management of acne vulgaris are prepared by our editorial team based on guidelines from the American Academy of Dermatology (AAD 2024), the British Photodermatology Group (BPG/BAD 2019), the Global Alliance to Improve Outcomes in Acne (GAIOA 2018), the French Working Group on Acne (FWG-A 2017), the Canadian Working Group on Acne (CWG-A...
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Diagnostic investigations
Microbiological testing
As per AAD 2024 guidelines:
Do not obtain routine microbiological testing in patients with acne.
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Consider obtaining lesion culture for the diagnosis of Gram-negative folliculitis in patients presenting with eruptive uniform pustules to nodules in periorificial areas, particularly in the setting of prolonged tetracycline treatment.
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Endocrinological testing
Medical management
Topical therapies: as per AAD 2024 guidelines, Offer multimodal therapy combining multiple mechanisms of action when managing acne with topical medications.
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Systemic antibiotics
Systemic retinoids
Hormonal agents
Nonpharmacologic interventions
Dietary modifications
As per AAD 2024 guidelines:
Insufficient evidence to recommend a low-dairy diet, low-whey diet, omega-3 fatty acids, or chocolate for the treatment of acne.
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Recognize that the available evidence on a low-glycemic-load diet for the treatment of acne is conflicting.
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Zinc supplements
Chemical peels
Alternative and complementary therapies
Therapeutic procedures
Intralesional corticosteroid injections: as per AAD 2024 guidelines, Offer intralesional corticosteroid injections as an adjuvant therapy in patients with larger acne papules or nodules.
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Use intralesional corticosteroid injections judiciously in patients at risk of acne scarring and/or for rapid improvement of inflammation and pain. Consider using a lower concentration and volume of corticosteroids to minimize the risks of local corticosteroid adverse events. ⁄
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Laser and light therapy
Radiofrequency microneedling
Surgical interventions
Patient education
General counseling: as per FWG-A 2017 guidelines, Counsel patients with acne regarding the following in order to improve adherence:
treatment (except isotretinoin) is not curative
treatment efficacy is not immediate, regular application and/or intake over several weeks is needed to obtain lesion improvement
maintenance therapy is mandatory once remission has been obtained by the induction regimen
local irritation frequently induced by topical treatments can be prevented by starting with application on alternating days and using moisturizers.
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