The AAD acne guidelines are the American Academy of Dermatology's updated guidance for managing acne vulgaris, the common form of acne. Published online January 30, 2024, they replace the 2016 guidelines with 18 evidence-based recommendations and 5 good practice statements, according to Dermatology Times read the Dermatology Times summary. Acne vulgaris means clogged pores, pimples, blackheads, whiteheads, and deeper inflamed lesions. The guidance helps readers and clinicians compare prescription and over-the-counter-style options and decide when to seek dermatology care.
Medical information disclaimer: This article is for general educational purposes only and does not provide medical advice, diagnosis, or treatment. Always consult a physician or other qualified health professional about symptoms, medications, tests, or treatment decisions.
Official resources:
- Read the original research from Dermatologytimes — Use this page to review the original research.
- Read the official guidance from Managedhealthcareexecutive — Use this primary source to verify the official guidance.
Table of Contents
- Who are the guidelines for?
- Which treatments have the strongest support?
- When is isotretinoin recommended?
- Which options are conditional?
- How should treatments be combined or limited?
- What did the evidence not support?
Who are the guidelines for?
The guidelines apply to adults, adolescents, and children aged 9 and older with acne vulgaris. They focus on treatments approved by the Food and Drug Administration and commonly used in the United States.
They do not cover acne-like rashes or acne caused by medication. A reader with a sudden drug-related breakout, a rash that does not look like typical acne, or severe pain and fever should get direct medical advice rather than use this guidance alone.
Which treatments have the strongest support?
The workgroup gave strong recommendations to several core treatments because benefits clearly outweigh risks, according to the American Academy of Dermatology see the AAD guideline summary. These include topical benzoyl peroxide, topical retinoids, topical antibiotics and fixed-dose combinations, and oral doxycycline. Topical retinoids named in the guidance include adapalene, tretinoin, tazarotene, and trifarotene.
Fixed-dose combinations pair active ingredients in one product, which can simplify daily use and improve consistency. Readers can use this list to ask focused questions. A useful question is whether a retinoid, benzoyl peroxide, or combination product fits the type and location of acne.
When is isotretinoin recommended?
Oral isotretinoin is strongly recommended for severe acne. It is also recommended for acne causing scars or major emotional and social burden, or acne that has not improved with standard oral or topical therapy. Treatment requires careful patient selection, informed consent, and monitoring of lipids and liver function.
That monitoring helps catch side effects early and decide whether treatment should continue, pause, or change. A reader with scarring, dark marks that persist, or acne that affects school, work, or mood should discuss referral promptly. Bring a list of past treatments, how long each was used, and any side effects.
Which options are conditional?
The guidelines conditionally recommend topical clascoterone, salicylic acid, and azelaic acid. They also conditionally recommend oral minocycline and sarecycline, combined oral contraceptives, and spironolactone. Conditional means benefits and burdens are closely balanced and the right choice depends on the person.
Factors include acne severity, other health conditions, pregnancy plans, side-effect risk, cost, and preference for topical or systemic treatment. Newer drugs clascoterone, sold as Winlevi and approved in 2020, and sarecycline, sold as Seysara and approved in 2018, received only conditional recommendations despite high-certainty evidence because high cost may limit fair access and insurance coverage, according to Managed Healthcare Executive read the cost-access report. Readers considering them should check coverage, prior-authorization rules, and lower-cost alternatives first.
How should treatments be combined or limited?
Good-practice advice favors using topical treatments together in ways that target different causes of acne. It also advises limiting systemic antibiotic use to reduce bacterial resistance. When an oral antibiotic is used, pair it with benzoyl peroxide plus other topicals rather than using the antibiotic alone.
Intralesional corticosteroid injections may be used as an added treatment for selected large, painful lesions. Doxycycline is preferred over minocycline because minocycline carries rare serious harms. Readers prescribed an oral antibiotic should ask how long to take it, what topicals to use with it, and when treatment will be reviewed.
What did the evidence not support?
The evidence was too limited to recommend chemical peels, laser and light devices, or microneedling. It was also too limited to recommend dietary changes, vitamins, or plant-based products.
There were also gaps in evidence on microbiology and hormone testing and on cost-effectiveness. For readers, the practical point is to be cautious about paying for add-on procedures or supplements marketed as proven acne cures.