Established by the French National Authority for Health, the ‘Clinical Practice Guidelines’ involves reviewing the guidelines of acne treatment and management. The Working Group comprised of 19 people including drug-safety specialists, dermatologists and general practitioners. Literature references were taken on the following topics such as physical therapies, acne grading systems, bacterial resistance to antibiotics, and the efficacy and safety of topical and systemic treatments.
The first version of the guideline and recommendations were submitted to a peer view group consisting of 51 physicians from different specialities, which represent those in the Working Group. They gave a formal opinion on the form and content of the guideline’s initial version, such as its readability, applicability and acceptability.
Recommendations for Systemic Treatments
There is low evidence of antibiotic efficacies on top of the risk of inducing bacterial resistance to those drugs. As such, the indication of topical antibiotics has been limited. They should always be used in combination with a topical agent such as retinoid, benzoyl peroxide or azelaic acid. Oral doxycycline or lymecycline prescriptions should be limited to 3 months and be combined with topical treatment.
For very severe acne, isotretinoin is recommended as first-line treatment, and as a second-line treatment for moderate to severe acne. There is no population-level data to support that isotretinoin increases the likelihood of depression by acne-suffering patients, however a rare individual risk could not be excluded. Before starting isotretinoin, patient must be informed regarding the potential risk of psychiatric disorders. They should also notify the treating physician of any mood or behaviour changes.
A combined oestrogen–progestin contraceptive which contains levonorgestrel is the recommended choice as first-line therapy, while norgestimate as the choice for second-line. If acne still persists despite dermatological treatments such as systemic antibiotics or topical treatments, other hormonal treatments should be considered as an alternative acne treatment.
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