Updated French Guidelines for the Management of Acne

Updated French best practice guidelines of acne management have been released.These are updates of guidelines initially released in 2007.They are being published in The British Journal of Dermatology.

Specific Recommendations

1. Antibiotics: After having analyzed the risk/benefit ratio of minocycline, French health authorities withdrew its indication for acne treatment in 2012.The guidelines recommend that topical antibiotics must always be combined with a topical agent (benzoyl peroxide, retinoid or azelaic acid).Oral lymecycline or doxycycline prescriptions should always be limited to 3 months and combined with topical treatment.


2. Isotretinoin: Isotretinoin is recommended as second-line treatment for moderate to severe acne and as first-line treatment for very severe acne.Before starting isotretinoin, the patient and his/her family circle must be informed of the potential risk of psychiatric disorders. Controversies concerning the potentially increased risk of depression and inflammatory bowel diseases have emerged.


3. Hormonal therapy: In May 2013 the French Medicines Agency (ANSM) suspended the marketing authorization of products containing cyproterone acetate/ethinylestradiol (2 mg/0·035 mg). Later on Pharmacovigilance Risk-Assessment Committee,PRAC concluded that the benefits of cyproterone acetate/ethinylestradiol (2 mg/0·035 mg) outweigh the risks and recommended the implementation of measures to minimize the risk of thromboembolism. Following this report ANSM withdrew the suspension.The guidelines recommend that when birth control is not required, combined oestrogen-progestin oral contraceptives are not indicated to treat acne.A combined oestrogen–progestin contraceptive containing levonorgestrel is recommended as first-line therapy, with norgestimate as the second-line choice.other hormonal treatments, including cyproterone acetate/ethinylestradiol (2 mg/0·035 mg), should be considered as an alternative.

Differences from other guidelines :

• Topical dapsone: Topical dapsone has not been included as a treatment modality as Working Group did not find any superiority or noninferiority over other topical treatments.


• Minocycline : Working Group found no evidence of a superiority of minocycline over other cyclines in acne treatment and expressed concerns on safety and therefore it was not recommended.


• Azithromycin :The WG considered conflicting results of different RCTs and only one trial demonstrating noninferiority was of too low level of evidence to recommend azithromycin in acne treatment.


• Trimethoprim–sulfamethoxazole: The WG didn't assess Trimethoprim–sulfamethoxazole in its technical review.


• Low-dose isotretinoin :The WG found a very low level of evidence to recommend low-dose isotretinoin.


• Oral spironolactone:Spironolactone was not included as acne secondary to hormonal diseases was not within the scope of these guidelines.