An international expert panel of dermatologists has published new recommendations on how to facilitate longitudinal and personalized acne care. The Personalising Acne: Consensus of Experts (PACE) panelists published these recommendations in the Journal of the American Academy of Dermatology International.
Current Gaps in Longitudinal, Personalized Acne Care
Approximately 38% of the 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.
Determining the Patient Profile
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
The expert panel also 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.
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.
The experts also noted that patients should be followed up within 3 months during the initiation phase of treatment. 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
During the maintenance treatment/modification phase, 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
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