NECASA I: A Practical Algorithm Integrating Skincare in the Management of Acne Patients in the Nordic European Countries

September 2024 | Volume 23 | Issue 9 | 782 | Copyright © September 2024


Published online September 1, 2024

doi:10.36849/JDD.8472

Peter Bjerring MD Dr Scia, Oxana Anckar MDb, Anneke Andriessen PhDc, Carl Kyrklund MD PhDd, Alyson Layton MB FRCPe, Anne Brigitte Thomas Nordal MDf, Cristina Oprica MD PhDg

aDepartment of Dermatology, Aalborg University Hospital, Aalborg, Denmark
bDiagnostisk Centrum Hud in Stockholm, Sweden
cRadboud UMC, Nijmegen and Andriessen Consultants, Malden, The Netherlands
dSkin Hospital/Suomen Ihosairaala, Finland
eClinical Lead Skin Research Centre, University of York, United Kingdom
fBergen, Norway
gDiagnostiskt Centrum Hud, Stockholm, Karolinska Institutet, Department of Laboratory Medicine, Division of Clinical Microbiology; Stockholm, Sweden

Abstract
Background: Acne vulgaris is a multifactorial dermatosis primary of the face and trunk. Erythema, pruritus, and xerosis are frequent adverse effects of first-line acne treatment and, if not appropriately counseled and managed, can exacerbate, leading to regimen nonadherence and poor outcomes.
Methods: A panel of six dermatologists (five from the Nordic European Countries and one from the UK) employed a modified Delphi method and reached a consensus on a practical acne treatment and maintenance algorithm integrating skincare based on the best available evidence, and the panel's clinical experience, and opinions.
Results: The Nordic European Countries Acne Skincare Algorithm (NECASA) recommends integrating skincare and nonprescription acne treatment into acne regimens, addressing the relative lack of standardized guidance on their use as mono or adjunctives to acne treatment. The algorithm uses stratification by acne subtype and discusses management approaches per type of acne (comedonal, papulopustular, and nodulocystic acne), severity (mild to moderate and severe), and maintenance treatment. Skincare monotherapy may reduce acne lesions and maintain clearance in patients with mild acne. Adjunctive skincare may enhance the efficacy and improve tolerability of acne treatment, reduce pigmentary alterations, and improve skin barrier function.
Conclusions: The NECASA algorithm may serve as a roadmap for integrating skincare in managing acne patients and tailoring acne treatment to improve adherence and tolerance to treatment and patient outcomes.

J Drugs Dermatol. 2024;23(9):782-788. doi:10.36849/JDD.8472

INTRODUCTION

Acne vulgaris is a multifactorial, chronic, relapsing dermatosis primary of the face and trunk. It is most commonly observed in adolescents and young adults and frequently results in significant social, psychological, and physical consequences. Its prevalence rates are estimated to range from 35% to over 90% among adolescents.1 The natural course of this disease can commence as early as ages 7 to 12 (preadolescent acne) and, in many patients, fails to resolve until the third decade of an individual's life.2-4 As well as persisting for several decades, acne can develop for the first time during adulthood; this post-adolescent persistent or last-onset acne predominantly affects females.2,3,5

The primary clinical lesions seen in acne, ranging from open and closed comedones to papules, pustules, and large nodulocystic lesions, carry material physical and psychosocial morbidity, as do the clinical sequelae, which commonly arise from acne and include persistent erythema, acne-induced hyperpigmentation (PIH)/pigment alteration (PIPA) and scar formation. These sequelae correlate with the duration of acne, highlighting the necessity to initiate timely and effective treatment.2,5-10 Some evidence suggests that certain racial and ethnic groups may experience variations in the severity, prevalence, and sequelae of acne, with patients with skin of color being more likely to develop PIPA.1,11
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