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Home » News

Publish Date August 23, 2022


PERSONALIZED LONG-TERM ACNE CARE RECOMMENDATIONS PUBLISHED

Brandon May

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A need for better patient education regarding the long-term nature of acne care
was found. Credit: Getty Images


An international expert panel of dermatologists has published new
recommendations on how to facilitate personalized, long-term acne treatment in
the Journal of the American Academy of Dermatology International.

CURRENT GAPS IN ACNE CARE

Approximately 38% of the Personalising Acne: Consensus of Experts (PACE)
panelists said they did not find current clinical practice guidelines on acne
particularly useful for supporting the long-term management of the condition. In
addition, 62% of the panelists said they did not find current guidelines useful
for the management of different types of patients with acne.

In addition, the PACE panel noted several challenges in the long-term management
of acne: multifactorial pathophysiology, presence of sequelae, variable presence
of clinical lesions, and lack of a definitive treatment target to utilize in a
treat-to-target strategy. All dermatologist experts endorsed a need for better
patient education regarding the long-term nature of acne care and indicated this
education may help patients make informed decisions regarding choice and
modification of therapy.

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DETERMINING THE PATIENT PROFILE WHEN OPTIMIZING ACNE CARE

The expert panel agreed that early and comprehensive evaluation of the patient’s
profile is an essential component of optimizing acne care. Several factors
related to the patient’s history could be assessed before the consultation.
These factors, according to the panelists, may include:

 * Acne location: facial vs truncal
 * Presence/risk of acne-induced scarring
 * Family history
 * Skin phototype
 * Acne duration
 * Length of previously unsuccessful management
 * Socioeconomic status
 * Parent/child dynamic

Also, the panel suggests clinicians should try to improve the patient-clinician
relationship and communication to ensure patients are satisfied with treatment
and feel supported in their care.

TOPICS TO CONSIDER DISCUSSING WITH PATIENTS WITH ACNE

The expert panel listed several topics clinicians should consider discussing
during the patient encounter:

 * Patient-reported satisfaction with acne treatment
 * Administration/application technique
 * Long-term treatment goals/expectations
 * Treatment duration
 * Adverse effects/tolerability
 * Importance of treatment compliance
 * Daily skincare routine
 * Risk of sequelae
 * Changes to the patient’s general medication or dietary patterns
 * Costs of treatment
 * Treatment access

The panel also recommends clinicians prioritize the above discussion topics
based on how the patient is responding to a prescribed therapy. Shared
decision-making is also recommended by the panel to facilitate personalized goal
setting.

ACNE TREATMENT INITIATION/MODIFICATION

During the treatment initiation/modification phase of acne treatment, the panel
recommends discussions with patients regarding treatment goals and expected
outcomes, available therapies, and antibiotic resistance. In addition, the panel
recommends evaluating potential reasons for prior nonadherence to acne
medications to ensure future management is adjusted accordingly.

Patients should be followed up within 3 months during the initiation phase of
treatment, the panel said. Frequency of follow-up could be increased if there
are any safety or tolerability concerns or issues with adherence. In contrast,
follow-up frequency could be decreased if the medication is well tolerated, the
patient is considered stable, adherence is good, and there is no evidence of
sequelae development.

The expert panel stated there is “a need to allow for an adjustment period to a
medication,” and suggests that the period over which a prescribed treatment
“would be expected to have an effect is an additional factor to consider when
determining how frequently to follow-up with patients.” In some patients who
have achieved an adequate treatment response, the panel noted treatment
de-escalation could be considered.

MAINTENANCE TREATMENT/MODIFICATION FOR ACNE

During the maintenance treatment/modification phase of acne treatment, the panel
recommends the following considerations:

 * Clinical indicators to start maintenance treatment
   * Goals of the initiation phase of treatment achieved
   * Patient satisfaction with treatment response, regimen, and appearance
 * Treatment duration with antibiotics
 * Age/sex of patient and associated risk of returning active acne
 * Patient preferences
 * Completion of the isotretinoin treatment course
 * Ongoing treatment costs

The panel suggests telemedicine platforms represent an acceptable approach to
conduct follow-up visits during the maintenance treatment/modification phase of
acne treatment, particularly if a patient is progressing well on maintenance
therapy. Goals that should be discussed with the patient during the maintenance
phase, according to the experts, include maintaining clear/almost-clear skin
achieved during the initiation phase; prevention of returning acne that is
unacceptable to the patient; and reduction of acne sequelae risk.

TREATMENT DISCONTINUATION

According to the panel, discontinuation of prescribed acne treatment can be
considered when patients’ and clinicians’ mutually developed management goals
have been met.

SEQUELAE MANAGEMENT

The panel noted that considerations for sequelae management should include risk
factors for sequelae, impact on quality of life, and skin phototype. Several
discussion topics were also described:

 * Acne sequelae should be discussed with patients at the initial consultation
   and revisited frequently
 * Managing expectations:
   * Discuss patients’ concerns around the effect of their disease
   * Discuss patients’ concerns around treatment
   * Discuss patients’ treatment expectations
   * Highlight that improvements may only be observed in the long term
   * Be realistic about outcomes
   * Emphasize the need for control of active disease to reduce the risk of
     developing sequelae
   * Emphasize the role of modifiable risk factors (eg, lesion excoriation,
     adherence to medication) in reducing the sequelae risk
 * Discuss management options for sequelae
 * Discuss correction procedures with patients

The PACE panel noted that the developed recommendations and discussion points
“provide practical and actionable recommendations to facilitate personalized,
longitudinal management of patients with acne.” The panel also stated that the
recommendations can be used to “inform local guideline development and patient
consultations, thus helping to optimize and personalize care throughout the
patient journey.”

Disclosure: This clinical trial was supported by Galderma. Multiple authors
declared affiliations with the pharmaceutical industry. Please refer to the
original article for a full list of disclosures.

REFERENCE

Tan J, Alexis A, Baldwin H, et al. The Personalised Acne Care
Pathway-Recommendations to guide longitudinal management from the Personalising
Acne: Consensus of Experts. JAAD Int. 2021;5:101-111.
doi:10.1016/j.jdin.2021.09.006

This article originally appeared on Dermatology Advisor


TOPICS:

Acne Dermatology Telemedicine


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