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Cited by 518Acne and Rosacea Treatments and EffectsDermatologic Treatments and ResearchClinical practice guidelines implementation

The DOI matches its Crossref record; 315 of the 358 references it cites were found in a registry or an index; 37 of the 191 sources its claims cite were checked for support.

Guidelines of care for the management of acne vulgaris

Open access
Reynolds, Rachel V., Yeung, Howa, Cheng, Carol E., Cook-Bolden, Fran, Desai, Seemal R., Druby, Kelly M., Freeman, Esther E., Keri, Jonette E., Stein Gold, Linda F., Tan, Jerry K.L., Tollefson, Megha M., Weiss, Jonathan S., Wu, Peggy A., Zaenglein, Andrea L., Han, Jung Min, Barbieri, John S.·2024·Journal of the American Academy of Dermatology
DOI 10.1016/j.jaad.2023.12.017
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Abstract

Background Acne vulgaris commonly affects adults, adolescents, and preadolescents aged 9 years or older. Objective The objective of this study was to provide evidence-based recommendations for the management of acne. Methods A work group conducted a systematic review and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of evidence and formulating and grading recommendations. Results This guideline presents 18 evidence-based recommendations and 5 good practice statements. Strong recommendations are made for benzoyl peroxide, topical retinoids, topical antibiotics, and oral doxycycline. Oral isotretinoin is strongly recommended for acne that is severe, causing psychosocial burden or scarring, or failing standard oral or topical therapy. Conditional recommendations are made for topical clascoterone, salicylic acid, and azelaic acid, as well as for oral minocycline, sarecycline, combined oral contraceptive pills, and spironolactone. Combining topical therapies with multiple mechanisms of action, limiting systemic antibiotic use, combining systemic antibiotics with topical therapies, and adding intralesional corticosteroid injections for larger acne lesions are recommended as good practice statements. Limitations Analysis is based on the best available evidence at the time of the systematic review. Conclusions These guidelines provide evidence-based recommendations for the management of acne vulgaris.

Overview

Integrity signals

Registry

Crossref · 10.1016/j.jaad.2023.12.017

Cites

315 of 315 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

37 of 191 cited sources checked · 13 supported · 3 flagged · accuracy not yet measured

Show all 76 claims

  • It may state two separate claims as one. 46
  • Probably not a substantial claim. 8
53 of 53

  • The paper relies on this without support.

    Cutibacterium acnes has specific culture requirements that prevent growth in routine bacterial culture.

    “C. acnes has specific culture requirements that prevent growth in routine bacterial culture.”

  • The paper relies on this without support.

    Routine microbiologic and/or antibiotic susceptibility testing does not affect acne management.

    “routine microbiologic and/or antibiotic susceptibility testing is not indicated for patients with acne since it does not affect management.”

  • The paper relies on this without support.

    Androgens such as testosterone and dehydroepiandrosterone sulfate have central roles in acne pathogenesis.

    “Androgens, such as testosterone and dehydroepiandrosterone sulfate, have central roles in the pathogenesis of acne.”

  • The paper relies on this without support.

    Polycystic ovarian syndrome is a common cause of hyperandrogenism, characterized by ovulatory dysfunction or polycystic ovaries on ultrasonography.

    “Polycystic ovarian syndrome is a common cause of hyperandrogenism, characterized by ovulatory dysfunction or polycystic ovaries on ultrasonography.”

  • The paper relies on this without support.

    Topical retinoids are comedolytic and anti-inflammatory, improve dyspigmentation, and enable maintenance of acne clearance.

    “Topical retinoids are vitamin A derivatives and serve as the cornerstone of acne treatment since they are comedolytic and anti-inflammatory, improve dyspigmentation, and enable maintenance of acne clearance.”

  • The paper relies on this without support.

    Each retinoid binds to a different set of retinoic acid receptors and confers modest differences in activity, tolerability and efficacy.

    “Each retinoid binds to a different set of retinoic acid receptors and confers modest differences in activity, tolerability and efficacy.”

  • The paper relies on this without support.

    Combining topical antibiotics with benzoyl peroxide enhances efficacy and may prevent antibiotic resistance development.

    “Combining topical antibiotics with BP enhances efficacy and may prevent antibiotic resistance development.”

  • The paper relies on this without support.

    Potential adverse effect profiles of fixed-dose combinations generally reflect those of the individual agents in summation.

    “Potential adverse effect profiles of the fixed-dose combinations generally reflect those of the individual agents in summation.”

  • The paper relies on this without support.

    Salicylic acid is a topical comedolytic agent available over the counter, with concentration ranging in 0.5% to 2%.

    “Salicylic acid is a topical comedolytic agent that is available over the counter, with concentration ranging in 0.5% to 2%.”

  • The paper relies on this without support.

    Tetracycline-class antibiotics are contraindicated in pregnancy, lactation, and childhood below age 9 years during tooth development, since repeated exposure may cause permanent teeth enamel hypoplasia or discoloration.

    “Notably, tetracycline-class antibiotics are contraindicated in pregnancy, lactation, and childhood below age 9 years during tooth development, since repeated exposure may cause permanent teeth enamel hypoplasia or discoloration.”

  • The paper relies on this without support.

    Increasing azithromycin use could increase antibiotic resistance.

    “increasing azithromycin use could increase antibiotic resistance.”

  • The paper relies on this without support.

    Tetracycline-class antibiotics can cause permanent teeth discoloration and inhibit bone growth in a fetus or nursing infant.

    “tetracyclineclass antibiotics should be avoided due to potential for permanent teeth discoloration and bone growth inhibition in the fetus or nursing infant.”

  • The paper relies on this without support.

    The high current cost of sarecycline may affect equitable access to acne treatment.

    “concerns about the high current cost of sarecycline treatment that may impact equitable acne treatment access.”

  • The paper relies on this without support.

    Rare potential adverse effects of minocycline, including vertigo, autoimmune hepatitis, skin hyperpigmentation, drug-induced lupus, and hypersensitivity syndrome, are concerns that justify a conditional recommendation.

    “concerns about rare potential adverse effects of minocycline, which include vertigo, autoimmune hepatitis, skin hyperpigmentation, drug-induced lupus, and hypersensitivity syndrome.”

  • The paper relies on this without support.

    Patient values and preferences regarding contraception vary.

    “variability in patient values and preferences related to contraception”

  • The paper relies on this without support.

    Broad use of antibiotics for acne can select for antibiotic-resistant bacteria.

    “broad use for acne should be discouraged to avoid selection of antibiotic-resistant bacteria.”

  • The paper relies on this without support.

    Depression, anxiety, and suicidal ideation/suicide are highly prevalent in the general population, especially among adolescents who may be candidates for isotretinoin therapy.

    “given high prevalence of depression, anxiety and suicidal ideation/suicide in the general population, and especially the adolescent population who may be candidates for isotretinoin therapy”

  • The paper relies on this without support.

    Standard isotretinoin has better bioavailability when taken with a high-fat meal, whereas lidose-isotretinoin bioavailability is less affected by food intake.

    “Standard isotretinoin has better bioavailability when taken with a high fat meal, whereas the bioavailability of lidose-isotretinoin is less affected by whether it is taken with food.”
18 of 18

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Salicylic-acid evidence is graded two ways

    Major

    The treatment section calls the evidence moderate certainty, while Table III grades the same recommendation as low certainty.

  • COC effect estimate falls outside its confidence interval

    Major

    The reported noninflammatory-lesion estimate is −19.45%, but its stated interval runs from −9.9% to −9.0%. The interval's midpoint is −9.45%, so it cannot contain the reported estimate.

    Reported -19.45 · recomputed -9.45

2 of 2

Citations

Cites

Flagged first, then by citations

Show all 358 references

43 of the 358 references couldn’t be matched to a known paper.

Research works printed but not linked: 5

  1. Paracha, 2020, Efficacy and safety of short term use of 0.1% tazarotene gel in the treatment of mild to moderate acne vulgaris: a randomized-vehicle controlled trial, J Postgrad Med Inst, 34, 134
  2. Eichenfield, 2016, Efficacy and safety of once-daily dapsone gel, 7.5% for treatment of adolescents and adults with acne vulgaris: second of two identically designed, large, multicenter, randomized, vehicle-controlled trials, J Drugs Dermatol, 15, 962
  3. Alexis, 2018, BPX-01 minocycline topical gel shows promise for the treatment of moderate-tosevere inflammatory acne vulgaris, J Clin Aesthet Dermatol, 11, 25
  4. Mazzetti, 2019, A phase 2b, randomized, double-blind vehicle controlled, dose escalation study evaluating clascoterone 0.1%, 0.5%, and 1% topical cream in subjects with facial, Acne, 1, 570
  5. Rosette, 2019, Cortexolone 17alpha-propionate (clascoterone) is a novel androgen receptor antagonist that inhibits production of lipids and inflammatory cytokines from sebocytes in vitro, J Drugs Dermatol, 18, 412

Cited by

Sorted by citations

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Metadata

Authors
Reynolds, R. V., Yeung, H., Cheng, C. E., Cook-Bolden, F., Desai, S. R., Druby, K. M., Freeman, E. E., Keri, J. E., Stein Gold, L. F., Tan, J. K. L., Tollefson, M. M., Weiss, J. S., Wu, P. A., Zaenglein, A. L., Han, J. M., & Barbieri, J. S.
Affiliations
  • Beth Israel Deaconess Medical Center (US)
  • Emory University (US)
  • University of California, Los Angeles (US)
  • Weill Cornell Medicine (US)
  • The University of Texas Southwestern Medical Center (US)
  • Pennsylvania State University (US)
  • Massachusetts General Hospital (US)
  • University of Miami (US)
  • Western University (CA)
  • Mayo Clinic (US)
  • University of California Davis Medical Center (US)
  • American Academy of Dermatology (US)
  • Brigham and Women's Hospital (US)
Corresponding author
Han, Jung Min
ORCID
Venue
Journal of the American Academy of Dermatology
Publisher
Elsevier BV
Published
2024-05
Volume
90
Issue
5
Pages
1006.e1-1006.e30
ISSN
0190-9622 (ISSN-L)
DOI
10.1016/j.jaad.2023.12.017
OpenAlex
W4391339756
Cited by
518
References
358
Citations by year
2026: 224 · 2025: 211 · 2024: 82
FWCI
209.33
Type
journal article
Language
en
Update notices
Open access
Licence
Locations
  • Journal of the American Academy of Dermatology (publishedVersion)
  • PubMed (publishedVersion)
Funders
American Academy of Dermatology
Topics
  • Health Sciences › Medicine › Dermatology › Acne and Rosacea Treatments and Effects
  • Health Sciences › Medicine › Dermatology › Dermatologic Treatments and Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Keywords
acne, acne treatment, benzoyl peroxide, topical retinoids, topical antibiotics, oral doxycycline, oral isotretinoin, clascoterone, salicylic acid, azelaic acid, minocycline, sarecycline, combined oral contraceptives, spironolactone, intralesional corticosteroids, scar formation, psychosocial burden
MeSH terms
Acne Vulgaris, Administration, Cutaneous, Administration, Oral, Adrenal Cortex Hormones, Anti-Bacterial Agents, Benzoyl Peroxide, Contraceptives, Oral, Combined, Cortodoxone, Dermatologic Agents, Dicarboxylic Acids, Doxycycline, Drug Therapy, Combination, Humans, Minocycline, Propionates, Retinoids, Spironolactone, Tetracyclines, Isotretinoin, Injections, Intralesional, Evidence-Based Medicine, Salicylic Acid

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

A language model drew the claims from the paper on 2026-09-30, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).

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Cited sources are checked with a language model’s help (gpt-6-sol).

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