Management of acne: Canadian clinical practice guideline

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Publisher: CMA Joule Inc.
Document Type: Article
Length: 5,541 words
Lexile Measure: 1670L

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Acne is one of the most burdensome diseases globally. (1,2) Its prevalence among those aged 12 to 24 years is estimated to be 85%, although it can persist beyond young adulthood despite treatment. (3-5) Acne can adversely affect quality of life (6-13) and may lead to emotional distress and physical scarring. (14,15) The clinical presentation of acne (Figure 1) varies from primarily comedonal to mixed comedonal and inflammatory acne. (16)

Since the last Canadian acne guideline was published in 2000, (17) evidence for multiple additional treatments has been published. Thus, there was an unmet need for an updated, systematically developed, evidence-based Canadian acne clinical practice guideline. This guideline provides recommendations adapted to the Canadian health care system to assist Canadian health care providers in the diagnosis of acne vulgaris, including investigations where appropriate; it also provides updated information on the pathogenesis of acne, outlines methods for evaluating acne severity, provides evidence-based guidance on treatments for acne vulgaris and recommends treatments for acne according to severity.

To support clinical practice, recommendations are made for three categories of acne severity: comedonal acne, which consists of small white papules (closed comedones) or grey-white papules (open comedones), which are due to complete or partial ductal occlusion, respectively, and sebum accretion (Figure 1A); mildto-moderate papulopustular acne, which is characterized by inflammatory lesions that are mostly superficial (Figures 1B and 1C); and severe acne, consisting of deep pustules and/or nodules, which may be painful, may extend over large areas and can lead to tissue destruction (Figures 1D and 1E). A subtype of severe acne, conglobate acne, is rare and consists of extensive inflammatory papules, nodules and cysts, which can lead to disfiguring scars. (16)


This guideline is intended for health care providers caring for patients with acne in Canada, specifically nurses, pharmacists, family physicians, pediatricians, obstetricians/gynecologists and dermatologists.

The recommendations in this guideline address acne vulgaris in pediatric and adult age groups, with the following exclusions: neonatal, infantile and late-onset acne; acne fulminans; acne inversa (hidradenitis suppurativa); and acne variants such as gram-negative folliculitis, rosacea, demodicidosis, pustular vasculitis, mechanical acne, oil or tar acne, and chloracne. These conditions were excluded because they have different pathogenic mechanisms. We also wished to maintain congruence with the source guideline for adaptation, the European Evidence-Based (S3) Guidelines for the Treatment of Acne (ES3). (16)


Guideline panel composition

Members of the guideline panel were selected by the steering committee (C.L. and J. Tan) according to acknowledged expertise in acne, as indicated by peer-reviewed publications and reputation. Dermatologists from disparate regions of Canada were included for geographic representation. Two experts with dual credentials in epidemiology and dermatology (Y.A. and A.B.) served as methodologic experts and performed literature evaluation and grading.

Guideline development

We developed this guideline in accordance with the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument (18) and the ADAPTE framework (19) for guideline adaptation.

In a systematic review of clinical practice guidelines on the management of acne published from 2007 to 2013, (20) we...

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Source Citation   

Gale Document Number: GALE|A442117679