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New Acne Guidelines Emphasize Importance of Retinoids: Presented at AAP
By Brian Reid
WASHINGTON, DC -- October 11, 2005 -- Physicians treating non-cystic acne should initiate therapy with a retinoid and maintain the use of that drug, even if other treatments are added to the therapy, according to new guidelines for the treatment of acne developed by the Global Alliance to Improve Outcomes in Acne.
Spearheaded by Diane Berson, Assistant Professor of Dermatology, Weill Medical College of Cornell University, and Attending Physician, New York-Presbyterian Hospital, New York, United States, the new guidelines followed an expert review of acne literature.
Fred Ghali, MD, Private Practitioner, Pediatric Dermatology of North Texas, Grapevine, Texas, presented the guidelines here on October 8th at the American Academy of Pediatrics (APP) National Conference and Exhibition.
The guidelines emphasize the importance of topical retinoid agents in treating not only viable lesions, but also acne precursors, and caution against overuse of oral antibiotics.
"The bottom line is that topical retinoids work on all classes of acne," Dr. Ghali said. "Doctors want to abandon the topical retinoids too early."
Patients with mild comedonal acne should be started with a retinol, he said, which target microcomedo -- microscopic precursors to the more-familiar blackheads and whiteheads.
Most patients will see results when adding a benzoperoxide or benzoperoxide/antibiotic combination, according to Dr. Ghali, allowing for both the anti-comedo effect of the topical retinoid and the antimicrobial effect of benzoperoxide and topical antibiotics.
Only for patients with moderate acne do the guidelines suggest the use of oral antibiotics -- once the mainstay of acne therapy -- and then only as long as systems persist. "Long-term use of antibiotics should be minimized," he said.
Dr. Ghali presented data showing that therapy with a retinol and benzoperoxide/topical antibiotic regimen was significantly better than benzoperoxide therapy alone, though differences in the treatment groups could take as long as 2 months to appear, underscoring the importance of maintaining the topical retinoid therapy.
Isotretinoin remains the treatment of choice for severe nodular acne, he said.
Improvements in the topical retinoids have made this treatment more tolerable and effective, he said. Adapalene appears less irritating than older members of the class, he added, and is more stable in light, so that patients do not have to worry about exposure to the sun.
[Presentation title: Expert Committee Recommendations for Acne Management.]
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