New insights into the management of acne: An update from the Global Alliance to Improve Outcomes in Acne Group - 07/08/11

Doi : 10.1016/j.jaad.2009.01.019

Diane Thiboutot, MD ^a,^⁎ : Author and Guest Editor, Harald Gollnick, MD ^b : Author and Guest Editor, Vincenzo Bettoli, MD ^c : Co-Author and Steering Committee, Brigitte Dréno, MD, PhD ^d : Co-Author and Steering Committee, Sewon Kang, MD ^e : Co-Author and Steering Committee, James J. Leyden, MD ^f : Co-Author and Steering Committee, Alan R. Shalita, MD ^g : Co-Author and Steering Committee, Vicente Torres Lozada, MD ^h : Co-Author and Steering Committee, Diane Berson, MD ⁱ : Co-Author and Global Alliance Member, Andrew Finlay, MBBS, FRCP ^j : Co-Author and Global Alliance Member, Chee Leok Goh, MD, MRCP, FRCP, FAMS ^k : Co-Author and Global Alliance Member, María Isabel Herane, MD ^l : Co-Author and Global Alliance Member, Ana Kaminsky, MD, PhD ^m : Co-Author and Global Alliance Member, Raj Kubba, MD ⁿ : Co-Author and Global Alliance Member, Alison Layton, MB, ChB, FRCP ^o : Co-Author and Global Alliance Member, Yoshiki Miyachi, MD, PhD ^p : Co-Author and Global Alliance Member, Montserrat Perez, MD ^q : Co-Author and Global Alliance Member, Jaime Piquero Martin, MD ^r : Co-Author and Global Alliance Member, Marcia Ramos-e-Silva, MD, PhD ^s : Co-Author and Global Alliance Member, Jo Ann See, MBBS, FACD ^t : Co-Author and Global Alliance Member, Neil Shear, MD, FRCPC ^u : Co-Author and Global Alliance Member, John Wolf, MD ^v : Co-Author and Global Alliance Member
Global Alliance to Improve Outcomes in Acne
^a Department of Dermatology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
^b Department of Dermatology and Venereology, Medical Faculty, Otto-von-Guericke-University, Magdeburg, Germany
^c Clinical Dermatologica at Arcispedale S. Anna, University of Ferrara, Ferrara, Italy
^d Hotel Dieu, Nantes, France
^e Department of Dermatology, Johns Hopkins Medicine, Baltimore, Maryland
^f University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
^g Department of Dermatology State University of New York Downstate Medical Center, Brooklyn, New York
^h Juarez Hospital, Mexico City, Mexico
ⁱ Department of Dermatology, Weill Medical College, New York, New York
^j Department of Dermatology, Cardiff University School of Medicine, Cardiff, United Kingdom
^k National Skin Center, Singapore
^l Department of Dermatology, University of Chile, Santiago, Chile
^m Department of Dermatology, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
ⁿ Delhi Dermatology Group, New Delhi, India
^o Department of Dermatology, Harrogate District Hospital, Harrogate, United Kingdom
^p Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
^q Hospital de San Pablo, Barcelona, Spain
^r Service of Dermatology, Institute of Biomedicine, Hospital Vargas, Caracas, Venezuela
^s Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
^t Central Sydney Dermatology, Sydney, Australia
^u Department of Dermatology, Sunnybrook and Women’s College Health Sciences Center, Toronto, Ontario, Canada
^v Department of Dermatology, Baylor College of Medicine, Houston, Texas

Reprint requests: Diane Thiboutot, MD, Department of Dermatology, The Pennsylvania State University College of Medicine, Hershey, PA.

Abstract

The Global Alliance to Improve Outcomes in Acne published recommendations for the management of acne as a supplement to the Journal of the American Academy of Dermatology in 2003. The recommendations incorporated evidence-based strategies when possible and the collective clinical experience of the group when evidence was lacking. This update reviews new information about acne pathophysiology and treatment–such as lasers and light therapy–and relevant topics where published data were sparse in 2003 but are now available including combination therapy, revision of acne scarring, and maintenance therapy. The update also includes a new way of looking at acne as a chronic disease, a discussion of the changing role of antibiotics in acne management as a result of concerns about microbial resistance, and factors that affect adherence to acne treatments. Summary statements and recommendations are provided throughout the update along with an indication of the level of evidence that currently supports each finding. As in the original supplement, the authors have based recommendations on published evidence as much as possible.

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Key words : acne, acne scarring, adherence, antibiotic resistance, lasers, maintenance, pathophysiology, retinoids

Abbreviations used : ALA, AP-1, BPO, CO₂, ECCA, ECOB, Er:YAG, FDA, HLA-DR, ICAM, ICG, IL, IPL, MAL, MMP, PDL, PDT, RF, TCA, TLR, VCAM

Plan

Introduction

Recognizing the chronicity of acne

Update: Pathogenesis of acne

Update: Treatment of acne

The changing role of antibiotics in managing acne

Retinoid-based combination therapy for acne

Does enough evidence now exist for using lasers and lights to treat inflammatory acne?

The role of topical retinoids in acne maintenance therapy

Management of acne scarring

Optimizing adherence with acne therapy

Studies of adherence in acne

Factors associated with adherence in acne

New tool to assess adherence validated

Global Alliance recommendations

The Global Alliance recommends assessment of adherence via verbal interview or use of a simple tool such as the ECOB questionnaire at each visit for patients with acne (level V Evidence)

Summary

	Supported by an educational grant from Galderma International.
	Disclosure: Dr Berson has served on advisory boards for Galderma, Kao, Stiefel, Dusa, Johnson & Johnson, and Ortho Neutrogena and received honoraria. Dr Bettoli has served as an investigator for Galderma, Intendis, Astellas, and La Roche Posay and a speaker for Galderma, Intendis, Astellas, Stiefel, and La Roche Posay and received grants in compensation. Dr Dréno has served on advisory boards for Galderma, La Roche Posay, and Expansicone and has been a speaker for Pierre Fabre and an investigator for Biollevis and received honoraria. Dr Finlay has served on advisory boards and as speaker for Galderma and Pierre Fabre and on advisory boards for York Pharma and has received grants or honoraria. Dr Goh has served as a consultant to Galderma and received travel grants. Dr Gollnick has served as an investigator and speaker for Schering, Stiefel, and Galderma, and on advisory boards for Galderma; in addition, he has been a consultant to Basilea and IMTM and has received honoraria for these duties. Dr Herane has served as an investigator for Bioderma, Vichy, and Isden and a speaker for Galderma and Stiefel and has received honoraria and other financial benefits for this work. Dr Kang has served as an investigator and consultant for Galderma and an investigator for Stiefel and has received honoraria or grant support. Dr Kubba has served as a consultant to Galderma and Schering-Plough and in another capacity for Ranbaxy and Janssen-Cilag and has received grants and honoraria. Dr Layton has served as an advisor, speaker, and investigator for Galderma and received grants and gravel grants and has also been an investigator for Roche, receiving grants. Dr Leyden has served as a consultant and on advisory boards for Allergan, Galderma, Obagi, SkinMedica, Medicis, and Stiefel and received grants and honoraria. Dr Miyachi has served on advisory boards for Galderma, Otsuka, and Sanofi-Aventis and has received grants and honoraria. Dr Piquero Martin has served as a speaker for Galderma and received benefits. Dr Ramos-e-Silva has served on advisory boards for Galderma, Johnson, Stiefel, Novartis, La Roche Posay, and Roche; she has been an investigator for Galderma, Johnson, Stiefel, Novartis, La Roche Posay, Biolab, Aventis, and Pfizer, and has been a speaker for Galderma, Johnson, Stiefel, Novartis, LaRoche Posay, Vichy, and Roche and has received honoraria or grant support. Dr See has received honoraria as a speaker for Galderma and L’Oreal. Dr Shalita has served as a consultant to Galderma, Stiefel, Allergan (including consultancies to companies acquired by these companies), Baxbier, Quinoa, and Ortho and has been an investigator for Galderma, Stiefel, and Allergan and has received grants and honoraria; he has stock options in Medicis. Dr Shear has served on advisory boards for Galderma, and as a consultant and other for Galderma and has received honoraria and residency or fellowship program funding; Dr Shear has also served as a consultant and other for Dermik and received honoraria and residency or fellowship program funding. Dr Torres Lozada has been a consultant and investigator for Galderma and has received honoraria. Dr Wolf has been an investigator for Galderma and Medicis, an advisory board member, consultant, and speaker for Galderma and Medicis, an advisory board member and consultant for QLT, and a speaker for Stiefel and Dermik; he has received grants and honoraria and has stock in Medicis. Drs Kaminsky, Perez, and Thiboutot have no conflicts of interest to declare.
	Preparation of the manuscript was a joint effort as follows. The manuscript outline, content development and selection of references, review of the data, and generation of the first draft were done in sections, with responsibilities as follows. “Recognizing the chronicity of acne” section: Drs Shear, Finlay, and Gollnick, and Ms Sanders. “Update: Pathogenesis of acne” section: Drs Thiboutot, Kang, and Gollnick, and Ms Sanders. “Update: Treatment of acne” was further subdivided into the following sections. “The changing role of antibiotics in managing acne” section: Drs Layton, Bettoli, Miyachi, Dréno, Perez, and Leyden, and Ms Sanders. “Retinoid-based combination therapy for acne” section: Drs Thiboutot, Kaminsky, Gollnick, Miyachi, Wolf, Herane, and Piquero Martin, and Ms Sanders. “Does enough evidence now exist for using lasers and lights to treat inflammatory acne?” section: Drs Leyden, Berson, Kang, See, Shalita, Torres Lozada, and Gollnick, and Ms Sanders. “The role of topical retinoids in acne maintenance therapy” section: Drs Gollnick, Bettoli, Thiboutot, and Leyden, and Ms Sanders. “Management of acne scarring” section: Drs Dréno, Goh, Kubba, Ramos-e-Silva, and Bettoli, and Ms Sanders. “Optimizing adherence with acne therapy” section: Drs Thiboutot, Dréno, Layton, Herane, and Dr Perez, and Ms Sanders. Ms Valerie Sanders is a medical writing consultant to Galderma International. Changes to the first draft and subsequent drafts were generated by each of the authors. All authors reviewed the complete final draft including all sections.