Updated Swiss Practice Recommendations for the Treatment of Acne.

Introduction: Acne is one of the most common skin diseases. It has a high impact on the quality of life of the affected patients. It is now recognized that in some patients, acne shows characteristics of a chronic disease. Because of a lack of current recommendations/guidelines in Switzerland, a group of hospital and private practice based dermatologists, specialized in acne, as well as an experienced general practitioner revised the available literature on acne and its treatment. The group subsequently developed several consensus statements regarding grading, treatment and monitoring of acne. The first version of the recommendations was published in 2020 and is now being updated. The experts agreed that acne severity should be determined by a subjective method and that, for short-term therapy, treatment success is defined as an approximately 50 % reduction of inflammatory lesions within 3 months. The choice of induction treatment is based on the severity of the disease. Its main component is a topical retinoid alone or - in more severe case - in combination with benzoyl peroxide (BPO). Only in moderate to severe forms of acne or if a more rapid resolution of inflammatory lesions is desired, a systemic antibiotic should be added to induction treatment. For severe acne with a tendency to scarring, systemic retinoids are the induction treatment of choice in the absence of contra-indications. Maintenance therapy is indicated in all patients with acne, independent of disease severity. The choice of maintenance therapy should always be based on acne severity, duration of disease, current treatment and history of relapse. The preferred options for maintenance therapy are topical retinoids with/without BPO. While treating acne, a special focus should lie on the prevention of scars. For this reason, patients should be evaluated 3 months after treatment initiation to determine whether they have responded or whether further therapeutic options should be considered. The expert group also recommends counselling patients on nutrition, psychological aspects, stress, use of contraceptives, skin care, use of cosmetics and use of other drugs (like steroids). Monitoring of patients with acne should particularly focus on adherence to treatment and quality of life. Patients with severe forms of acne (acne with a tendency of scarring, patients with acne conglobata or acne fulminans), patients with insufficient treatment response after 3 months and patients with frequent relapses should be referred to a dermatologist.