RESUMEN
BACKGROUND: Acne vulgaris commonly affects adults, adolescents, and preadolescents aged 9 years or older. OBJECTIVE: The objective of this study was to provide evidence-based recommendations for the management of acne. METHODS: A work group conducted a systematic review and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of evidence and formulating and grading recommendations. RESULTS: This guideline presents 18 evidence-based recommendations and 5 good practice statements. Strong recommendations are made for benzoyl peroxide, topical retinoids, topical antibiotics, and oral doxycycline. Oral isotretinoin is strongly recommended for acne that is severe, causing psychosocial burden or scarring, or failing standard oral or topical therapy. Conditional recommendations are made for topical clascoterone, salicylic acid, and azelaic acid, as well as for oral minocycline, sarecycline, combined oral contraceptive pills, and spironolactone. Combining topical therapies with multiple mechanisms of action, limiting systemic antibiotic use, combining systemic antibiotics with topical therapies, and adding intralesional corticosteroid injections for larger acne lesions are recommended as good practice statements. LIMITATIONS: Analysis is based on the best available evidence at the time of the systematic review. CONCLUSIONS: These guidelines provide evidence-based recommendations for the management of acne vulgaris.
Asunto(s)
Acné Vulgar , Antibacterianos , Peróxido de Benzoílo , Fármacos Dermatológicos , Ácidos Dicarboxílicos , Doxiciclina , Isotretinoína , Ácido Salicílico , Espironolactona , Humanos , Acné Vulgar/tratamiento farmacológico , Isotretinoína/administración & dosificación , Isotretinoína/uso terapéutico , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Fármacos Dermatológicos/administración & dosificación , Fármacos Dermatológicos/uso terapéutico , Peróxido de Benzoílo/administración & dosificación , Peróxido de Benzoílo/uso terapéutico , Ácidos Dicarboxílicos/administración & dosificación , Ácidos Dicarboxílicos/uso terapéutico , Espironolactona/administración & dosificación , Espironolactona/uso terapéutico , Doxiciclina/administración & dosificación , Doxiciclina/uso terapéutico , Ácido Salicílico/administración & dosificación , Ácido Salicílico/uso terapéutico , Medicina Basada en la Evidencia/normas , Administración Oral , Retinoides/administración & dosificación , Retinoides/uso terapéutico , Tetraciclinas/administración & dosificación , Tetraciclinas/uso terapéutico , Adolescente , Minociclina/administración & dosificación , Minociclina/uso terapéutico , Niño , Administración Cutánea , Anticonceptivos Orales Combinados/administración & dosificación , Anticonceptivos Orales Combinados/uso terapéutico , Quimioterapia Combinada , Femenino , Corticoesteroides/administración & dosificación , Corticoesteroides/uso terapéutico , Inyecciones Intralesiones , Adulto , Cortodoxona/análogos & derivados , PropionatosRESUMEN
Oral and topical zinc have been used for the treatment of acne, but there is a lack of definitive evidence for their efficacy. (a) To determine if mean serum zinc levels differ between acne patients and controls and (b) to determine the efficacy of zinc preparations in the treatment of acne. A systematic review and meta-analysis was performed according to recommended PRISMA [Preferred Reporting Items for Systematic Reviews and Meta-Analyses] guidelines. Subjects with acne had significantly lower serum zinc levels compared to controls. Patients who were treated with zinc had a significant improvement in mean inflammatory papule count compared to those who were not treated with zinc. There was no significant difference in the incidence of side effects in zinc supplementation vs comparators. Acne patients have decreased serum zinc levels. Zinc is effective for the treatment of acne, particularly at decreasing the number of inflammatory papules, when used as monotherapy or as an adjunctive treatment.
Asunto(s)
Acné Vulgar , Zinc , Acné Vulgar/diagnóstico , Acné Vulgar/tratamiento farmacológico , Pruebas Diagnósticas de Rutina , Humanos , Compuestos OrgánicosRESUMEN
BACKGROUND: Despite the several studies suggesting the genetic basis of acne vulgaris, the exact genetic architecture of this very common condition is not yet clear. AIM OF THE WORK: This study aimed to investigate the association between IL-1A (-889) gene polymorphism and acne vulgaris in a sample of patients. SUBJECTS AND METHOD: Blood samples from 100 patients with acne vulgaris and 100 healthy age, sex, and BMI matched controls were obtained. DNA samples were isolated from blood cells, and the PCR-RFLP method was used for genotyping. RESULTS: The genotype distributions of IL-1A (-889) polymorphism were as expected under Hardy-Weinberg equilibrium. T allele was predominant in the patients, while C allele predominated in the control subjects (P value < .001). The frequency of TT genotype in patients was significantly higher than in the control subjects (P value < .001). CT genotype was significantly more frequent in the control subjects compared to patients (P value < .001). Among the 47 patients who reported diet as a risk factor for triggering or exacerbating their lesions, 62.5% had TT genotype (P value = .038). CONCLUSION: IL-1A (-889) gene polymorphism has a role in the pathogenesis of acne vulgaris. We suggest that the triggering or exacerbating effect of diet on acne may be related to IL-1A (-889) gene polymorphism.
Asunto(s)
Acné Vulgar/genética , Dieta , Interleucina-1alfa/genética , Adolescente , Estudios de Casos y Controles , Femenino , Predisposición Genética a la Enfermedad , Genotipo , Humanos , Masculino , Polimorfismo Genético , Factores de Riesgo , Adulto JovenRESUMEN
Acne is one of the most common disorders treated by dermatologists and other health care providers. While it most often affects adolescents, it is not uncommon in adults and can also be seen in children. This evidence-based guideline addresses important clinical questions that arise in its management. Issues from grading of acne to the topical and systemic management of the disease are reviewed. Suggestions on use are provided based on available evidence.