Background: Current acne treatment guidelines offer extensive, evidence-based recommendations. However, their complexity can be challenging to implement in routine clinical settings.
Objective: This Daily Guide aims to provide simplified, consensus-driven algorithms for managing acne in everyday office-based practice. It also includes practical checklists to help clinicians identify reasons for treatment failure and guide subsequent actions.
Methods: We reviewed existing acne treatment guidelines and consensus papers, extracting and simplifying key information to create user-friendly algorithms tailored for daily clinical needs. These algorithms are based on a consensus approach and the authors’ extensive clinical experience in dermatology.
Results: This guide presents distinct, streamlined algorithms for treating different types of acne: predominantly comedonal, predominantly papulopustular, and nodular/conglobate acne.
For comedonal acne, initial treatment recommendations include topical retinoids, azelaic acid, or salicylic acid.
For papulopustular acne, fixed combination topical medications are recommended, with treatment intensity adjusted according to disease severity.
For nodular/conglobate acne, recommended treatments include oral isotretinoin or fixed topical combinations combined with oral antibiotics in male patients. In female patients, these options can be supplemented with oral anti-androgenic hormonal therapy.
Treatment response should be evaluated after 8 weeks for comedonal and papulopustular acne, and after 12 weeks for nodular/conglobate acne. Once acne is clear or almost clear, maintenance therapy with a topical retinoid or azelaic acid should be initiated to prevent recurrence.
Lack of treatment response can generally be attributed to five main categories: disease progression, non-drug-related factors, drug-related factors, poor treatment adherence, and adverse events. Checklists are provided within this guide to assist in systematically evaluating these potential causes.
Conclusion: This daily guide provides dermatologists with practical, easy-to-implement treatment algorithms for various clinical presentations of acne. The accompanying checklists for identifying the causes of treatment non-response and suggesting subsequent steps will support more effective acne management in daily practice, ultimately improving patient outcomes.
