Acne Treatment
Acne treatment is one of the most frequent reasons for dermatological consultation. In many instances, the recommendations provided by medical guidelines become outdated over time following their publication. To address this, Dr. Cristina Eguren Michelena updated the daily clinical practice of dermatologists regarding this condition, going beyond what is stipulated in the product package inserts.
Use of isotretinoin, antibiotics
During his presentation on the “Real-World Use of Isotretinoin, Antibiotics, and Contraceptives in Acne”—held as part of the session “Therapeutics in Inflammatory Pathology: From Package Insert to Clinical Practice” this Saturday, the 21st—304 dermatologists participated in the 2020 Virtual Autumn Congress.
“In my presentation, I wanted to reflect what actually happens in clinical practice versus what appears in the product’s technical specifications. Gaining a realistic perspective on what other dermatologists are doing proves to be of great assistance in one’s own individual practice,” Dr. Eguren Michelena explained to the AEDV website.
That The Guides And Actual Practice
The problem often lies in the significant disconnect between clinical guidelines and actual practice; consequently, in many instances, what the guidelines recommend does not align with what practitioners do in their day-to-day work. So, what are the most common approaches to acne treatment? And when is the dosage recommended in the product information leaflet actually used?
For example, the product information leaflet for isotretinoin states that this drug is intended to treat severe forms of acne—such as nodular acne or acne conglobata—that carry a risk of permanent scarring.
“I typically use this drug in cases of acne that are not quite as severe, at lower doses, as well as to treat other conditions such as rosacea, seborrhea, or the papules associated with frontal fibrosing alopecia.”
The survey reveals that 90% of dermatologists use isotretinoin outside the indications specified in the product information leaflet to treat moderate acne and rosacea; 65% use it for facial papules associated with frontal fibrosing alopecia; 45% for mild acne and seborrhea; 30% for anti-aging purposes; and 20% for seborrheic dermatitis and other indications.
“The dosage used varies depending on the indication, but generally speaking, many dermatologists tend to employ either lower doses or the specific doses explicitly listed in the product information leaflet,” notes this dermatologist, emphasizing the notable variability that exists among different medical guidelines.
Analytical control and monitoring
Discrepancies also exist between what guidelines recommend regarding the performance of blood tests and what dermatologists actually do. 99% of dermatologists order blood tests; of these, only 3% request an initial test followed by monthly monitoring; 50% request an initial test and a subsequent verification (ordering no further tests if the result is favorable); and 46% request a test at the start and at every follow-up visit. These discrepancies are not limited solely to the relationship between guidelines and dermatologists, but also vary among the different clinical guidelines themselves.
