EADV: New Acne Guidelines Identify Topical Retinoids as Mainstay of Acne Therapy

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EADV: New Acne Guidelines Identify Topical Retinoids as Mainstay of Acne Therapy

By Jill Stein

BARCELONA, SPAIN -- October 24, 2003 -- Topical retinoids should be used alone or in combination with oral antibiotics as first-line therapy for mild-to-moderate acne, a panel of dermatology experts announced here on October 17th at the 12th Annual Meeting European Association of Dermatology and Venereology.

The recommendation provides the framework for new acne treatment guidelines that were developed by an international panel of dermatology experts as part of the Global Alliance to Improve Outcomes in Acne. The new guidelines target dermatologists, paediatricians, and primary care physicians.

The guidelines state that, in addition to comedonal acne, topical retinoids alone or in combination should be used as first-line therapy for inflammatory acne. Topical retinoids are also the preferred agent for maintenance therapy in lieu of long-term maintenance with antibiotics, which leads to bacterial resistance. The goal is to minimise the use of antibiotics.

"Regrettably, many physicians still use oral antibiotics alone to treat acne," said Dr. James Leyden, professor of dermatology, University of Pennsylvania, Philadelphia, Pennsylvania United States. "It is important that physicians recognise that topical retinoids such as adalapene or tretinoin, when combined with oral antibiotics, provide faster and more sustained reduction of lesions than antibiotics alone."

Historically, topical retinoids have been used only in patients with mild acne involving blackheads or whiteheads, while cases of moderate and severe inflammatory acne have been treated with oral antibiotics. The guidelines, however, are based on a large body of evidence that demonstrates convincingly that topical retinoid therapy significantly improves inflammatory acne and should be used at the start of treatment. A topical or oral antibiotic can then be added to achieve a significantly larger and more rapid effect.

Dr. Leyden, who helped develop the new guidelines, also noted that combining a topical retinoid with an antibiotic simultaneously targets three major areas of acne pathophysiology. These include abnormal desquamation, Propionibacterium (P) acnes proliferation, and inflammation. Topical retinoids act both to normalise desquamation and reduce inflammatory lesions, while antibiotics decrease inflammation and kill P acnes.

The guidelines also call for use of topical retinoids in dark-skinned patients because of evidence demonstrating that these agents help improve and avoid skin discoloration and scarring typical in acne patients of color. Studies suggest that adalapene, in particular, is well suited for the treatment of acne in patients with dark skin.

According to the guidelines, hormonal therapy may be indicated in women with moderate to severe acne. In most cases, hormonal therapy should be combined with other anti-acne therapies, including antibiotics and topical retinoids.

Oral isotretinoin, an oral retinoid, is first-line treatment in severe acne and may also be used in patients who have failed conventional treatment or who have chronic acne prone to relapse.

Acne is the most common skin disorder, affecting roughly 85% of individuals some time between the ages of 12 and 24 years. The condition also occurs in about 8 % of adults 25 to 34 years of age and 3% of persons 35 to 44 years of age. Approximately 20% of visits to dermatologists are consultations for acne.