Clinical Review

Acne vulgaris

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2634 (Published 08 May 2013) Cite this as: BMJ 2013;346:f2634
  1. Annelise L Dawson, medical resident1,
  2. Robert P Dellavalle, chief234
  1. 1Department of Internal Medicine, Brigham and Women’s Hospital, Boston, MA, USA
  2. 2Department of Dermatology, University of Colorado Denver, Aurora, Colorado, USA
  3. 3Dermatology Service, Department of Veterans’ Affairs Medical Center, Denver, CO 80220, USA
  4. 4Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA
  1. Correspondence to: R P Dellavalle, Dermatology Service, Department of Veteran Affairs Medical Center, Denver, CO, USA robert.dellavalle{at}ucdenver.edu

Summary points

  • Do not underestimate the impact of acne on patient quality of life and mental health

  • Topical retinoids are now a mainstay of treatment

  • Avoid prolonged antibiotic courses and antibiotic monotherapy because of the risk of bacterial resistance

  • For women with refractory acne or lesions confined to the lower half of the face, consider the addition of combined oral contraceptives

  • Oral isotretinoin is the most effective treatment for severe acne

  • Assess treatment adherence, which may be limited by irritation or regimen complexity

Acne vulgaris is a common inflammatory skin condition. Although often perceived as a self limited disease of adolescence, its prevalence remains high into adulthood. Nearly 90% of teenagers have acne, and half of them continue to experience symptoms as adults.1 2 3 By age 40 years, 1% of men and 5% of women still have lesions.4 Recent analyses show an increasing prevalence of acne in children, perhaps because of pubertal onset.5

Given that acne may persist for decades and require long term therapy, there has been a recent effort to reclassify acne as a chronic disease.2 6 Acne has clear detrimental psychosocial effects and may lead to permanent scarring.7 It is therefore not surprising that patients are motivated to seek medical care. In the United Kingdom, acne accounts for more than 3.5 million annual visits to general practitioners,3 8 who must therefore be equipped to treat acne. Several prominent groups—including the Global Alliance to Improve Outcomes in Acne, the European Dermatology Forum, and the American Academy of Dermatology—have published comprehensive treatment recommendations detailing comparable therapeutic strategies.9 10 11 Here we provide a streamlined outline of treatment intended for the non-specialist.

Sources and selection criteria

We performed a Medline database search using the term “acne” together with “antibiotic resistance”, “antibiotics”, “azelaic acid”, “benzoyl peroxide”, “classification”, “depression”, “diet”, …

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