AAD Acne Guidelines: Management Algorithm

Overview / Definition Acne vulgaris is a chronic inflammatory skin condition characterized by the presence of comedones, papules, pustules, and, in severe cases, nodules and cysts. It predominantly affects the face, chest, and back and is primarily seen in adolescents and young adults, although it can persist or begin in adulthood. Epidemiology Acne is one of the most common dermatological disorders, affecting approximately 85% of individuals at some point during their lifetime. It typically begins during puberty due to hormonal changes and can continue into adulthood, particularly in females. Peak incidence: Ages 12-24. Higher prevalence in males during adolescence, but females may experience more persistent acne. Acne can lead to significant psychological distress and social stigmatization. Pathophysiology / Mechanism The pathogenesis of acne involves a combination of factors: Follicular hyperkeratinization: Increased shedding of keratinocytes leads to clogged hair follicles. Increased sebum production: Androgens stimulate sebaceous glands, resulting in excess oil. Propionibacterium acnes: Commensal bacteria that proliferate in clogged pores, leading to inflammation. Inflammation: Immune response to bacterial overgrowth and blocked follicles. Clinical Presentation Acne can present in various forms: Comedonal acne: Open (blackheads) and closed (whiteheads) comedones. Inflammatory acne: Papules and pustules. Nodulocystic acne: Painful, deep nodules and cysts. Distribution: Primarily on the face, chest, back, and shoulders. Diagnosis / Workup The diagnosis of acne is primarily clinical. Consider the following steps: History: Assess the duration, severity, and impact on quality of life. Physical examination: Evaluate the type and distribution of lesions. Differential diagnosis: Consider other conditions such as rosacea, folliculitis, or hormonal disorders. Treatment / Management The AAD recommends a stepwise management approach based on acne severity: Mild acne: Topic