and found that the clinical features were similar in adolescents and adults.8 The authors concluded that acne severity was associated with the male gender, the use of cosmetics, age of onset, and signs of hyperandrogenism.8
Acne is a chronic disease that needs long-term management. Acne can significantly impact the quality of life (QoL) and psychosocial well-being with associated increases in anxiety, depression, and low self-esteem.10 Racial/ethnic differences in the clinical presentation, sequelae, and desired treatment outcomes for acne have been reported.11-16 PIH frequently occurs in SOC patients who have acne and, for many patients, can be a more significant concern than acne lesions.9-16
Published reports and expert experience suggest that strategies for improving outcomes in SOC patients with acne include: (1) the early initiation and maintenance of efficacious treatment regimens to minimize or prevent sequelae; (2) careful consideration of tolerability of active ingredients, vehicle formulations, and dosing; and (3) the use of adjunctive skincare - including pH balanced, non-irritating cleansers and non-comedogenic moisturizers - to minimize irritation or dryness.12-16
Acne is a chronic disease that needs long-term management. Acne can significantly impact the quality of life (QoL) and psychosocial well-being with associated increases in anxiety, depression, and low self-esteem.10 Racial/ethnic differences in the clinical presentation, sequelae, and desired treatment outcomes for acne have been reported.11-16 PIH frequently occurs in SOC patients who have acne and, for many patients, can be a more significant concern than acne lesions.9-16
Published reports and expert experience suggest that strategies for improving outcomes in SOC patients with acne include: (1) the early initiation and maintenance of efficacious treatment regimens to minimize or prevent sequelae; (2) careful consideration of tolerability of active ingredients, vehicle formulations, and dosing; and (3) the use of adjunctive skincare - including pH balanced, non-irritating cleansers and non-comedogenic moisturizers - to minimize irritation or dryness.12-16
SCOPE
The algorithm addresses acne vulgaris in pediatric and adult groups with SOC and aims to inform dermatologists and other health care professionals caring for patients with acne who have SOC.
METHODS
The project used a modified Delphi hybrid process comprising face-to-face discussions followed by an online review process.17,18 A previously published review16 by the authors (advisors) gave guidance for developing the current practical algorithm. The process entailed preparing the project, selecting the advisors based on published experience on this topic, conducting structured literature searches, summarizing the literature search results, grading the literature, and drafting the algorithm.17,18 On March 24, 2022, the advisors convened to discuss the structured literature review results and draft the algorithm by integrating evidence and the clinical expertise of the advisors. A further online process was used to refine the algorithm and prepare and review the publication. Finally, a consensus was obtained on the algorithm by all advisors.
Structured Literature Searches
A structured literature search was conducted to identify publications on racial/ethnic differences in the clinical presentation, sequelae, and desired treatment outcomes for SOC patients with acne. Literature describing current best-practice: treatment, maintenance, and skin care, including cleansers and moisturizers for SOC patients with acne, was identified in searches prior to the panel meeting. The selected literature included clinical guidelines, algorithms, consensus papers, systematic literature reviews, and clinical studies involving the treatment of SOC patients with acne. Specific questions addressed ethnic/racial differences in clinical presentation, medical and nonprescription treatment, maintenance, skin care, perception, behaviors, and impact of acne. Further questions addressed sequela, pigmentary disorders, and PIH.
A dermatologist and a physician/scientist carried out the structured literature searches on February 22, 2022. Searches were conducted on PubMed and Google Scholar (secondary source) of the English-language literature (2010–2022). Excluded were papers with no original data (unless a review article was deemed relevant) and those that were published in a language other than English.
The structured literature searches on self-identified racial/ethnic groups and regions, including African, Asian, and Hispanic patients with acne, used the following keywords: Ethnic/racial differences in clinical acne presentation; perception; behaviors and impact; sequelae; pigmentary disorders; PIH; scarring; treatment; maintenance; skincare as monotherapy and adjunct; cleansers; moisturizers; emollients; ceramides; ceramide containing skincare; efficacy, safety, tolerability, skin irritation using treatment or skincare.
The selected publications were manually reviewed for additional resources.
The searches identified 136 papers, of which 58 were excluded as duplications, having poor quality, or not including SOC or skin care. Seventy-eight papers remained, of which 43 addressed SOC patients with acne. The included publications comprised 30 clinical studies (24/30 SOC patients with acne), 10 guidelines, algorithms, consensus papers, and systematic literature reviews (6/10 included recommendations for SOC), 11 epidemiology and QoL (4/11 had SOC data), and 27 reviews or books (9/27 included information on acne in SOC).
The grading system comprised study type (A [clinical double-blind, randomized controlled trial of high quality], B [Randomized clinical trial of lesser quality], or C [trial with severe limitations]) and levels 1 to 4 to assess the likelihood of change in the confidence of the shown treatment effect (1 = unlikely, 4 = highly likely).19 The grading system19 is particularly useful for developing practical clinical guidelines and algorithms as the applied clinical evidence may also reflect new challenges and
Structured Literature Searches
A structured literature search was conducted to identify publications on racial/ethnic differences in the clinical presentation, sequelae, and desired treatment outcomes for SOC patients with acne. Literature describing current best-practice: treatment, maintenance, and skin care, including cleansers and moisturizers for SOC patients with acne, was identified in searches prior to the panel meeting. The selected literature included clinical guidelines, algorithms, consensus papers, systematic literature reviews, and clinical studies involving the treatment of SOC patients with acne. Specific questions addressed ethnic/racial differences in clinical presentation, medical and nonprescription treatment, maintenance, skin care, perception, behaviors, and impact of acne. Further questions addressed sequela, pigmentary disorders, and PIH.
A dermatologist and a physician/scientist carried out the structured literature searches on February 22, 2022. Searches were conducted on PubMed and Google Scholar (secondary source) of the English-language literature (2010–2022). Excluded were papers with no original data (unless a review article was deemed relevant) and those that were published in a language other than English.
The structured literature searches on self-identified racial/ethnic groups and regions, including African, Asian, and Hispanic patients with acne, used the following keywords: Ethnic/racial differences in clinical acne presentation; perception; behaviors and impact; sequelae; pigmentary disorders; PIH; scarring; treatment; maintenance; skincare as monotherapy and adjunct; cleansers; moisturizers; emollients; ceramides; ceramide containing skincare; efficacy, safety, tolerability, skin irritation using treatment or skincare.
The selected publications were manually reviewed for additional resources.
The searches identified 136 papers, of which 58 were excluded as duplications, having poor quality, or not including SOC or skin care. Seventy-eight papers remained, of which 43 addressed SOC patients with acne. The included publications comprised 30 clinical studies (24/30 SOC patients with acne), 10 guidelines, algorithms, consensus papers, and systematic literature reviews (6/10 included recommendations for SOC), 11 epidemiology and QoL (4/11 had SOC data), and 27 reviews or books (9/27 included information on acne in SOC).
The grading system comprised study type (A [clinical double-blind, randomized controlled trial of high quality], B [Randomized clinical trial of lesser quality], or C [trial with severe limitations]) and levels 1 to 4 to assess the likelihood of change in the confidence of the shown treatment effect (1 = unlikely, 4 = highly likely).19 The grading system19 is particularly useful for developing practical clinical guidelines and algorithms as the applied clinical evidence may also reflect new challenges and
