based on clinical trials in patients with acne.33 The guidelines recommend combining skin care with topical drugs to reduce skin irritation from the drugs, improve treatment effect, and help treatment adherence.33 The Ibero-Latin American acne algorithm discusses the risk of PIH for richly pigmented skin and incorporates skin care and sunscreens in combination with medical treatment (Figure 5).34 An international group of clinical experts developed a personalized acne care pathway to guide the longitudinal management of acne.27 The acne care pathway states that priority discussion points should be tailored to the individual patient with acne, including daily skincare routine and considering QoL impact, skin phototype, and sequelae risk.27 The acne care pathway states that the risk of acne-induced macular hyperpigmentation should be examined, particularly in patients with richly pigmented skin who have acne.27 This important aspect of preventing acne sequelae deserves more attention from healthcare professionals caring for patients with acne.39
Chinese acne guidelines have addressed a combination of traditional and Western medicine for acne, which includes skin care.35 The South-East Asian and Singapore acne guidelines address the risk of PIH and the need to reduce inflammation.36,37 The South African acne guidelines also include skin care as part of the total acne management approach.38
Using adjunctive skin care, including cleansers and moisturizers, may reduce adverse events resulting from topical acne drugs.16,27,40-43 Skincare products for patients with acne should be pH-balanced, non-comedogenic, fragrance-free, and nonirritating. 16,40-43
Individual or cultural variations in skincare preferences should be considered to support adherence to skincare use.16,25,26,41,42 The advisors recommended that moisturizers may be applied before or after topical prescription agents to reduce unwanted side effects of prescription acne treatments (eg, drying, stinging). Product recommendations vary depending on the primary intended use of the products (ie, as a stand-alone therapy; as an adjunct to treatment; for maintenance of treatment results).
Complementary procedures
Comedo extraction, chemical peels, intralesional corticosteroid injection, and microdermabrasion may complement acne treatment.16,42 A 6- to 8-week course of a topical retinoid before comedonal extraction may facilitate the procedure and is recommended in SOC patients to help reduce cutaneous trauma and PIH.16,42
Assessment and type of acne
The algorithm's second section defines the profile of a SOC patient with acne.27 Examination and discussion with the patient (parents/caretaker) include a full patient history and family history of acne, QoL, and sequelae.27 Further assessment should include acne location, type of acne, self-identified ethnic/racial skin type, risk or presence of PIH or scarring, duration of acne, and length of previous unsuccessful treatment.34
Treatment of acne
The algorithm uses the following categories of acne severity: Comedonal acne, papulopustular acne (mild, moderate, severe), and nodulocystic acne (mild, moderate, severe). A further category is acne relapse, acne-related sequelae such as PIH and scarring. Treatment and maintenance care recommendations for all categories are based on first-line therapies recommended in the selected guidelines29-38 and which treatment is deemed appropriate for the individual patient taking into account the factors about the individual with acne and previous treatment(s) results.27
Every 2-3 months, the patient’s status should be evaluated to determine the need for ongoing treatment, including maintenance.32 During follow-up appointments, response to treatment, satisfaction with the treatment and the results, duration of antibiotic use, tolerability, adverse events, and risk factors for acne relapse and sequelae should be discussed.27
