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Presentation

AAD Acne Guidelines 2024: The Good, the Bad, the Ugly, the Right & the Wrong

Description

In the discussion on the AAD Acne Guidelines 2024, the speaker emphasizes the evolution of these guidelines, highlighting the transition from the earlier Sort system to the current Grade system, which influences how evidence is assessed and recommendations are made. The speaker critiques the inherent biases within the guidelines, pointing out that while the intention is to provide evidence-based recommendations, biases are introduced based on conflicts of interest and the economic evaluation of treatments. A mix of good practice statements and conditional recommendations for various acne treatments, including benzoyl peroxide, topical retinoids, and systemic therapies, is presented, with an emphasis on multimodal therapy. However, many recommendations are overly complicated, deviating from past straightforward formats, which could hinder patient care. The limitations of current guidelines are noted, particularly regarding the lack of robust evidence for several treatments and categories, such as hormonal therapies and dietary impacts. The speaker concludes with a call to recognize the biases and shortcomings within the guideline process, advocating for a return to a more straightforward, evidence-focused framework that prioritizes patient welfare above economic implications.

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Conclusions

The 2024 acne guidelines include five solid good-practice statements.
There is a tendency to prioritize form over function in the new guidelines, particularly with the GRADE system.
A significant concern includes bias related to cost affecting treatment recommendations.
Despite high efficacy data, treatments can be downgraded solely based on their current costs, which may disadvantage patients.
The guidelines aim for inclusive recommendations rather than judgmental ones, yet bias issues persist.
Multimodal therapy combining various therapeutic mechanisms is recommended as best practice for treating acne.
Topical agents like benzoyl peroxide and retinoids are strongly recommended, but not as monotherapies.
Systemic antibiotics should be limited to reduce antibiotic resistance, emphasizing guidelines against monotherapy.
Hormonal agents show promise but lack extensive comparative studies; recommendations exist for intralesional corticosteroids in specific cases.
Further research is needed on diverse populations and the long-term effects of acne treatments.

Reynolds, R et al ., J Am Acad Dermatol 2024;90:1006.e1-30