RESUMO
Background: Acne is very common, can cause considerable negative impact on quality of life and there is increasing concern over the use of long courses of oral antibiotics for this condition. Objectives: (1) To critically appraise reporting in acne guidelines and compare this with previous systematic review of acne guidelines. (2) Examine acne treatment guidance on pre-specified acne treatments of interest and compare between acne guidelines. Methods: Searches for new or updated guidelines were carried out in MEDLINE, Embase, Google Scholar, LILACS from 1 January 2017 to 31 July 2021, supplemented by searching a guideline-specific depository and checking for updates to guidelines included in previous review. We included guidelines, consensus statements or care protocols on the medical treatment of acne vulgaris in adults and/or children and excluded those that focused on a single intervention or subgroup of acne, regional adaptations of guidelines or guidelines included in previous review. AGREE II checklist was applied to critically appraise reporting of guidelines. Results were synthesised narratively. Results: Of 807 abstracts identified nine guidelines were identified that were eligible for inclusion. All guidelines had AGREE II scores above average in at least one domain and reporting was substantially improved compared to the systematic review of acne carried out 5 years previously. There was consensus between guidelines on the key role of topical treatments as first-line acne treatment and most recommended continuing topical treatments as maintenance therapy. There was considerable variation between guidelines on classification of severity, indications for commencing oral antibiotics and on maximum duration of oral antibiotics. However, there was consensus on the need for co-prescription of a non-antibiotic topical treatment when using oral antibiotics. There were notable differences on recommendations regarding provision of information for patients on how to use topical treatments or how to mitigate against side effects. Conclusions: Substantial differences in classification of acne severity hampered comparisons between guidelines. Although development and reporting of guidelines has improved over the past 5 years, differences in key recommendations remain, possibly reflecting uncertainties in the underlying evidence base. Differences between guidelines could have substantial implications for prevalence of antibiotic prescribing for acne.
RESUMO
BACKGROUND: Acne is a common skin condition, affecting most adolescents at some point. While guidelines recommend topical treatments first-line, long courses of oral antibiotics are commonly prescribed. AIM: To explore GPs' perspectives on managing acne. DESIGN AND SETTING: Qualitative interview study with GPs in South West England. METHOD: GPs were invited to participate via existing email lists used by GP educators to disseminate information. Purposive sampling was used to recruit a range of participants by sex, number of years in practice, and whether their practice was rural or urban. Semi-structured telephone interviews followed an interview guide and were audiorecorded and transcribed. Data were explored using inductive thematic analysis facilitated by NVivo software (version 11). RESULTS: A total of 102 GPs were invited, of whom 20 participated. Analysis revealed uncertainties regarding topical treatments, particularly around available products, challenges regarding side effects, and acceptability of topical treatments. GPs generally either perceived topical treatments to be less effective than oral antibiotics or perceived pressure from patients to prescribe oral antibiotics due to patients' views of topical treatments being ineffective. GPs described a familiarity with prescribing oral antibiotics and expressed little concern about antimicrobial stewardship in the context of acne. Some seemed unaware of guidance suggesting that antibiotic use in acne should not exceed 3 months, while others spoke about avoiding difficult conversations with patients regarding discontinuation of antibiotics. CONCLUSION: GPs expressed uncertainty about the use of topical treatments for acne and either felt that treatments were of low effectiveness or perceived pressure from patients to prescribe oral antibiotics.
