Addressing gaps in acne management: New expert recommendations to optimize patient care
An individualized approach to acne management is needed. Recommendations from the Personalising Acne: Consensus of Experts (PACE) and the Personalised Acne Care Pathway (PACP) allow clinicians to optimize their patient acne consultations to facilitate personalized, longitudinal care1
Truncal acne should be proactively discussed in consultations and managed with equal importance to facial acne2
Acne sequelae should be considered and discussed with all patients throughout their journey, with prevention and mitigation of sequelae a key goal of acne treatment3
Lausanne, Switzerland – December 14, 2021 – The PACE panel of 13 expert dermatologists have generated new recommendations and developed a clinical ‘road map’, to help doctors manage their patients’ acne better, and improve patient outcomes through personalized care. This consensus shines a light on the need for greater awareness and proactive management of combined facial and truncal acne, and acne sequelae, in addition to personalized, longitudinal care. The results of these three reports from a modified Delphi approach, led by co-chairs Professor Jerry Tan and Professor Alison Layton, are recently published in JAAD International.1–3
The PACP, developed by the PACE panel, is a practical tool to help doctors address all domains of acne management from first visit through treatment and eventual discontinuation, and highlights points to consider that may influence management decisions and contains discussion topics to help facilitate personalized care. Focus areas include1:
The importance of assessing a patient’s individual profile, e.g., family history and risk of sequelae, acne location
Prioritizing topics for discussion with patients to ensure they feel supported e.g., satisfaction with treatment, application technique
Setting achievable, individualized goals with the patient and managing expectations (including timeframes)
Reviewing, assessing, and modifying treatment while considering tolerability concerns, adherence issues, development of sequelae and adequacy of response to treatment
"With personalization at the heart of these new recommendations, the PACP complements existing clinical practice guidelines by providing a framework to manage patients in a dynamic and holistic way.”
PROFESSOR JERRY TAN
PACE CO-CHAIR, WESTERN UNVERSITY, CANADA
Key recommendations for truncal acne (in addition to facial acne) and acne sequelae patient management are also published in JAAD International.2,3
The panel advocates prompting patients to discuss truncal acne during consultations to identify those who would benefit from treatment. Personalized treatment, taking into consideration burden of disease and patient- and treatment-related factors, is also recommended.2
Additionally, the panel proposes clinicians discuss acne sequelae during the first consultation with all patients and assess individual risk of sequelae.3 All experts agree family history is an important factor.3 The need for control of active acne is emphasized and the role of modifiable risk factors were highlighted as essential for managing patients’ expectations.3 Visual aids and digital aids are recommended as practical strategies for improving acne sequelae management.3
"The importance of addressing acne scarring early on in the patient journey cannot be overstated. Recognising the risk factors and taking steps to mitigate them is critical from the outset if we are going to minimize sequelae in our patients.”
PROFESSOR ALISON LAYTON
PACE CO-CHAIR, UNIVERSITY OF YORK, UK
Acne is a common skin disease that consists of non-inflammatory (open and closed comedones) and inflammatory lesions (papules and pustules). It is estimated to affect up to 85% of people aged 12–24 years, however, it can also affect a significant proportion of individuals outside this age bracket.4,5 Acne is primarily known to affect the face, although around half of those with facial acne are also affected on their shoulders, chest and back (known as truncal acne).6,7 If acne is not adequately controlled, or if an individual has certain risk factors, it can lead to long-term physical effects including scarring and pigment changes (known as acne sequelae).8
Both active acne and its sequelae can lead to emotional distress, a negative impact on acne sufferers’ school, work and social lives, and poor mental health.8 Although facial acne is well researched and is addressed in clinical management guidelines9–11, some aspects of acne – such as truncal acne, acne sequelae and long-term management – need more attention.8,10,12
About the PACE panel
The Personalising Acne: Consensus of Experts panel included 13 dermatologists from Canada, France, Germany, Italy, the U.K, and the U.S.A. Panelists reached consensus on critical aspects of acne evaluation and management by a modified Delphi approach (e-surveys and virtual group meetings), by voting on each statement: strongly disagree, disagree, agree, or strongly agree (consensus defined as ≥75% agree/strongly agree). Statements that did not reach consensus in e-surveys were refined through nominal group discussion in a virtual group meeting and re-voted on. All voting was electronic and blinded.
PACE panel members were invited by Galderma, who funded the planning and delivery of this project but was not involved in the voting or handling of data.
Galderma is the world’s largest independent dermatology company, present in approximately 100 countries. Since our inception in 1981, we have been driven by a complete dedication to dermatology. We deliver an innovative, science-based portfolio of sophisticated brands and services across Aesthetics, Consumer Care and Prescription Medicine. Focused on the needs of consumers and patients, we work in partnership with healthcare professionals to ensure superior outcomes. Because we understand that the skin we’re in shapes our life stories, we are advancing dermatology for every skin story. For more information: www.galderma.com.
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- Tan J, 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.
- Tan J, et al. Gaps and recommendations for clinical management of truncal acne from the Personalising Acne: Consensus of Experts. JAAD Int 2021;5:33–40.
- Layton AM, et al. Identifying gaps and providing recommendations to address shortcomings in the investigation of acne sequelae by the Personalising Acne: Consensus of Experts. JAAD Int 2021;5:41–48.
- Bhate K, Williams HC. Epidemiology of acne vulgaris. Br J Dermatol 2013;168:474–485.
- Hay RJ, et al. The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions. J Invest Dermatol 2014;134:1527–1534.
- Del Rosso JQ, et al. A closer look at truncal acne vulgaris: prevalence, severity, and clinical significance. J Drugs Dermatol 2007; 6:597–600.
- Tan J, et al. Prevalence and severity of facial and truncal acne in a referral cohort. J Drugs Dermatol. 2008;7(6):551–556.
- Layton AM, et al. Reviewing the global burden of acne: how could we improve care to reduce the burden? Br J Dermatol 2020;184:219–225.
- Nast A, et al. European evidence-based (S3) guideline for the treatment of acne - update 2016 - short version. J Eur Acad Dermatol Venereol 2016;30:1261–1268.
- Zaenglein AL, et al. Guidelines of care for the management of acne vulgaris. JAAD Int 2016;74:945–973
- Asai Y, et al. Management of acne: Canadian clinical practice guideline. CMAJ 2016;188:118–126.
- Tan JKL, Dirschka T. A New Era for Truncal Acne: Emerging from a Legacy of Neglect. Dermatol Ther (Heidelb) 2021;11:665–668