Update to acne vulgaris treatment for Canadian practice

To provide updates and apply the new 2024 American Academy of Dermatology (AAD) guidelines of care for the management of acne vulgaris (AV) to Canadian practice and summarize current evidence-based practices, treatments, and emerging trends in acne management.

As per published guidelines, MEDLINE and Embase databases were searched for literature on the effectiveness and safety of available and approved treatments for AV in patients aged 9 and older in the United States. Studies meeting patient or population, intervention, comparison, and outcomes (PICO) criteria were extracted, and quality was assessed using the Cochrane Risk of Bias tool. A Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to classify evidence certainty as high, moderate, low, or very low, and categorize recommendations as strong or conditional. The federal Drug and Health Product Register was then searched for approved and marketed treatments currently available in Canada.

Topical therapies such as benzoyl peroxide, antibiotics, and fixed-dose combinations received strong recommendations, while retinoids, clascoterone, salicylic acid, and azelaic acid received conditional recommendations. Topical minocycline is not yet available in Canada. Oral therapies such as doxycycline and isotretinoin received strong recommendations, while minocycline, combined oral contraceptives, and spironolactone received condition recommendations. Isotretinoin remains the criterion standard for treating severe acne and scarring; frequent monitoring is unnecessary for most patients receiving oral isotretinoin, and it is unlikely to be associated with neuropsychiatric disorders or inflammatory bowel disease. Intralesional corticosteroids were also strongly recommended for acne at high risk of scarring. Additional consideration must be given to pregnant individuals, people with skin of colour, and those undergoing gender-affirming therapy.

The 2024 AAD guidelines provide a valuable framework for Canadian management of AV. Mild cases are managed with topical treatments, while moderate to severe cases often require oral medication. Antibiotic monotherapy is discouraged; combination with benzoyl peroxide may mitigate antibiotic resistance. Treatments using multiple modalities and mechanisms of action are recommended.