{
    "name": "The Acne Treatment Evidence Map",
    "description": "Acne treatments coded on two variables that are almost never published together: the strength of the clinical guideline recommendation, and the certainty of the evidence behind it.",
    "source": "https://tipsforacne.com/acne-treatment-evidence-map/",
    "license": "https://creativecommons.org/licenses/by/4.0/",
    "attribution": "TipsForAcne.com — please link back if you use this.",
    "based_on": "American Academy of Dermatology 2024 guidelines of care for the management of acne vulgaris. Rows outside that guideline's scope (chiefly scars and pigmentation) are graded from a named systematic review instead and are marked \"Not assessed in the guideline\".",
    "citation": "Reynolds RV, Yeung H, Cheng CE, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2024.",
    "disclaimer": "Research reference, not medical advice. Written by a non-clinician who links every claim to its source.",
    "last_updated": "2026-09-25",
    "count": 58,
    "fields": {
        "treatment": "Name of the acne treatment or intervention.",
        "availability": "Over the counter, prescription, in clinic, or self-directed.",
        "category": "OTC topical, prescription topical, oral medication, in-clinic procedure, diet & supplements, or scars & marks.",
        "guideline_position": "Strong recommendation, conditional recommendation, conditional recommendation AGAINST, good practice statement, evidence judged insufficient, evidence called conflicting, or not assessed in the guideline.",
        "certainty_of_evidence": "GRADE certainty rating: High, Moderate, Low, Very low, or Not graded.",
        "typical_time_to_judge_response": "How long before a treatment can reasonably be assessed."
    },
    "treatments": [
        {
            "treatment": "Adapalene + benzoyl peroxide (fixed dose)",
            "availability": "OTC and prescription strengths",
            "category": "Over-the-counter topical",
            "guideline_position": "Strong recommendation",
            "certainty_of_evidence": "Moderate",
            "typical_time_to_judge_response": "4–12 weeks"
        },
        {
            "treatment": "Adapalene 0.1% (OTC retinoid)",
            "availability": "Over the counter",
            "category": "Over-the-counter topical",
            "guideline_position": "Strong recommendation",
            "certainty_of_evidence": "Moderate",
            "typical_time_to_judge_response": "8–12 weeks, often worse before better"
        },
        {
            "treatment": "Benzoyl peroxide",
            "availability": "Over the counter",
            "category": "Over-the-counter topical",
            "guideline_position": "Strong recommendation",
            "certainty_of_evidence": "Moderate",
            "typical_time_to_judge_response": "4–12 weeks"
        },
        {
            "treatment": "Clindamycin + benzoyl peroxide (fixed dose)",
            "availability": "Prescription",
            "category": "Prescription topical",
            "guideline_position": "Strong recommendation",
            "certainty_of_evidence": "Moderate",
            "typical_time_to_judge_response": "6–12 weeks"
        },
        {
            "treatment": "Clindamycin + tretinoin (fixed dose)",
            "availability": "Prescription",
            "category": "Prescription topical",
            "guideline_position": "Strong recommendation",
            "certainty_of_evidence": "Moderate",
            "typical_time_to_judge_response": "8–12 weeks"
        },
        {
            "treatment": "Oral doxycycline",
            "availability": "Prescription",
            "category": "Oral medication",
            "guideline_position": "Strong recommendation",
            "certainty_of_evidence": "Moderate",
            "typical_time_to_judge_response": "6–12 weeks; usually capped at 3–4 months"
        },
        {
            "treatment": "Tazarotene",
            "availability": "Prescription",
            "category": "Prescription topical",
            "guideline_position": "Strong recommendation",
            "certainty_of_evidence": "Moderate",
            "typical_time_to_judge_response": "8–12 weeks"
        },
        {
            "treatment": "Topical clindamycin",
            "availability": "Prescription",
            "category": "Prescription topical",
            "guideline_position": "Strong recommendation",
            "certainty_of_evidence": "Moderate",
            "typical_time_to_judge_response": "6–12 weeks"
        },
        {
            "treatment": "Topical dapsone",
            "availability": "Prescription",
            "category": "Prescription topical",
            "guideline_position": "Strong recommendation",
            "certainty_of_evidence": "Moderate",
            "typical_time_to_judge_response": "8–12 weeks"
        },
        {
            "treatment": "Topical erythromycin",
            "availability": "Prescription",
            "category": "Prescription topical",
            "guideline_position": "Strong recommendation",
            "certainty_of_evidence": "Moderate",
            "typical_time_to_judge_response": "6–12 weeks"
        },
        {
            "treatment": "Topical minocycline foam",
            "availability": "Prescription",
            "category": "Prescription topical",
            "guideline_position": "Strong recommendation",
            "certainty_of_evidence": "Moderate",
            "typical_time_to_judge_response": "8–12 weeks"
        },
        {
            "treatment": "Tretinoin",
            "availability": "Prescription",
            "category": "Prescription topical",
            "guideline_position": "Strong recommendation",
            "certainty_of_evidence": "Moderate",
            "typical_time_to_judge_response": "8–12 weeks, often worse before better"
        },
        {
            "treatment": "Tretinoin + benzoyl peroxide (encapsulated, Twyneo)",
            "availability": "Prescription",
            "category": "Prescription topical",
            "guideline_position": "Strong recommendation",
            "certainty_of_evidence": "Moderate",
            "typical_time_to_judge_response": "8–12 weeks"
        },
        {
            "treatment": "Trifarotene",
            "availability": "Prescription",
            "category": "Prescription topical",
            "guideline_position": "Strong recommendation",
            "certainty_of_evidence": "Moderate",
            "typical_time_to_judge_response": "8–12 weeks"
        },
        {
            "treatment": "Intralesional corticosteroid injection",
            "availability": "In clinic",
            "category": "In-clinic procedure",
            "guideline_position": "Good practice statement",
            "certainty_of_evidence": "Not graded",
            "typical_time_to_judge_response": "24–72 hours for one lesion"
        },
        {
            "treatment": "Oral isotretinoin",
            "availability": "Prescription, with a pregnancy prevention programme",
            "category": "Oral medication",
            "guideline_position": "Good practice statement",
            "certainty_of_evidence": "Not graded",
            "typical_time_to_judge_response": "4–6 months for a typical course; improvement often continues after stopping"
        },
        {
            "treatment": "Clascoterone 1% cream (Winlevi)",
            "availability": "Prescription",
            "category": "Prescription topical",
            "guideline_position": "Conditional recommendation",
            "certainty_of_evidence": "High",
            "typical_time_to_judge_response": "12 weeks"
        },
        {
            "treatment": "Oral sarecycline",
            "availability": "Prescription",
            "category": "Oral medication",
            "guideline_position": "Conditional recommendation",
            "certainty_of_evidence": "High",
            "typical_time_to_judge_response": "12 weeks"
        },
        {
            "treatment": "Azelaic acid",
            "availability": "OTC 10% and prescription 15–20%",
            "category": "Over-the-counter topical",
            "guideline_position": "Conditional recommendation",
            "certainty_of_evidence": "Moderate",
            "typical_time_to_judge_response": "4–12 weeks; longer for marks"
        },
        {
            "treatment": "Combined oral contraceptive pills",
            "availability": "Prescription",
            "category": "Oral medication",
            "guideline_position": "Conditional recommendation",
            "certainty_of_evidence": "Moderate",
            "typical_time_to_judge_response": "3–6 months"
        },
        {
            "treatment": "Oral minocycline",
            "availability": "Prescription",
            "category": "Oral medication",
            "guideline_position": "Conditional recommendation",
            "certainty_of_evidence": "Moderate",
            "typical_time_to_judge_response": "6–12 weeks"
        },
        {
            "treatment": "Spironolactone",
            "availability": "Prescription",
            "category": "Oral medication",
            "guideline_position": "Conditional recommendation",
            "certainty_of_evidence": "Moderate",
            "typical_time_to_judge_response": "3–6 months"
        },
        {
            "treatment": "Salicylic acid",
            "availability": "Over the counter",
            "category": "Over-the-counter topical",
            "guideline_position": "Conditional recommendation",
            "certainty_of_evidence": "Low",
            "typical_time_to_judge_response": "4–8 weeks"
        },
        {
            "treatment": "Low-glycaemic-load diet",
            "availability": "Self-directed",
            "category": "Diet & supplements",
            "guideline_position": "Evidence called conflicting",
            "certainty_of_evidence": "Not graded",
            "typical_time_to_judge_response": "10–12 weeks in the trials"
        },
        {
            "treatment": "Chemical peels for active acne",
            "availability": "In clinic",
            "category": "In-clinic procedure",
            "guideline_position": "Evidence judged insufficient",
            "certainty_of_evidence": "Not graded",
            "typical_time_to_judge_response": "A series of 3–6 sessions"
        },
        {
            "treatment": "Chocolate avoidance",
            "availability": "Self-directed",
            "category": "Diet & supplements",
            "guideline_position": "Evidence judged insufficient",
            "certainty_of_evidence": "Not graded",
            "typical_time_to_judge_response": "Unclear"
        },
        {
            "treatment": "Comedo extraction",
            "availability": "In clinic",
            "category": "In-clinic procedure",
            "guideline_position": "Evidence judged insufficient",
            "certainty_of_evidence": "Not graded",
            "typical_time_to_judge_response": "Immediate for the lesion extracted"
        },
        {
            "treatment": "Flutamide",
            "availability": "Prescription",
            "category": "Oral medication",
            "guideline_position": "Evidence judged insufficient",
            "certainty_of_evidence": "Not graded",
            "typical_time_to_judge_response": "Unclear"
        },
        {
            "treatment": "Lasers and light devices for active acne",
            "availability": "In clinic",
            "category": "In-clinic procedure",
            "guideline_position": "Evidence judged insufficient",
            "certainty_of_evidence": "Not graded",
            "typical_time_to_judge_response": "A series of sessions"
        },
        {
            "treatment": "Low-dairy or low-whey diet",
            "availability": "Self-directed",
            "category": "Diet & supplements",
            "guideline_position": "Evidence judged insufficient",
            "certainty_of_evidence": "Not graded",
            "typical_time_to_judge_response": "Unclear"
        },
        {
            "treatment": "Metformin",
            "availability": "Prescription",
            "category": "Oral medication",
            "guideline_position": "Evidence judged insufficient",
            "certainty_of_evidence": "Not graded",
            "typical_time_to_judge_response": "Unclear for acne"
        },
        {
            "treatment": "Omega-3 fatty acid supplements",
            "availability": "Over the counter",
            "category": "Diet & supplements",
            "guideline_position": "Evidence judged insufficient",
            "certainty_of_evidence": "Not graded",
            "typical_time_to_judge_response": "Unclear"
        },
        {
            "treatment": "Oral azithromycin",
            "availability": "Prescription",
            "category": "Oral medication",
            "guideline_position": "Evidence judged insufficient",
            "certainty_of_evidence": "Not graded",
            "typical_time_to_judge_response": "Variable"
        },
        {
            "treatment": "Oral corticosteroids",
            "availability": "Prescription",
            "category": "Oral medication",
            "guideline_position": "Evidence judged insufficient",
            "certainty_of_evidence": "Not graded",
            "typical_time_to_judge_response": "Days, for flares"
        },
        {
            "treatment": "Oral or topical zinc",
            "availability": "Over the counter",
            "category": "Diet & supplements",
            "guideline_position": "Evidence judged insufficient",
            "certainty_of_evidence": "Not graded",
            "typical_time_to_judge_response": "Unclear"
        },
        {
            "treatment": "Oral pantothenic acid (vitamin B5)",
            "availability": "Over the counter",
            "category": "Diet & supplements",
            "guideline_position": "Evidence judged insufficient",
            "certainty_of_evidence": "Not graded",
            "typical_time_to_judge_response": "Unclear"
        },
        {
            "treatment": "Photodynamic therapy",
            "availability": "In clinic",
            "category": "In-clinic procedure",
            "guideline_position": "Evidence judged insufficient",
            "certainty_of_evidence": "Not graded",
            "typical_time_to_judge_response": "A series of sessions"
        },
        {
            "treatment": "Resorcinol",
            "availability": "Over the counter",
            "category": "Over-the-counter topical",
            "guideline_position": "Evidence judged insufficient",
            "certainty_of_evidence": "Not graded",
            "typical_time_to_judge_response": "Unclear"
        },
        {
            "treatment": "Sodium sulfacetamide",
            "availability": "OTC and prescription",
            "category": "Over-the-counter topical",
            "guideline_position": "Evidence judged insufficient",
            "certainty_of_evidence": "Not graded",
            "typical_time_to_judge_response": "Unclear"
        },
        {
            "treatment": "Sulfur",
            "availability": "Over the counter",
            "category": "Over-the-counter topical",
            "guideline_position": "Evidence judged insufficient",
            "certainty_of_evidence": "Not graded",
            "typical_time_to_judge_response": "Unclear"
        },
        {
            "treatment": "Tea tree oil",
            "availability": "Over the counter",
            "category": "Over-the-counter topical",
            "guideline_position": "Evidence judged insufficient",
            "certainty_of_evidence": "Not graded",
            "typical_time_to_judge_response": "Slower than benzoyl peroxide in the one comparison trial"
        },
        {
            "treatment": "Topical glycolic acid",
            "availability": "Over the counter",
            "category": "Over-the-counter topical",
            "guideline_position": "Evidence judged insufficient",
            "certainty_of_evidence": "Not graded",
            "typical_time_to_judge_response": "Unclear"
        },
        {
            "treatment": "Topical green tea",
            "availability": "Over the counter",
            "category": "Over-the-counter topical",
            "guideline_position": "Evidence judged insufficient",
            "certainty_of_evidence": "Not graded",
            "typical_time_to_judge_response": "Unclear"
        },
        {
            "treatment": "Topical niacinamide",
            "availability": "Over the counter",
            "category": "Over-the-counter topical",
            "guideline_position": "Evidence judged insufficient",
            "certainty_of_evidence": "Not graded",
            "typical_time_to_judge_response": "8–12 weeks if at all"
        },
        {
            "treatment": "Trimethoprim/sulfamethoxazole",
            "availability": "Prescription",
            "category": "Oral medication",
            "guideline_position": "Evidence judged insufficient",
            "certainty_of_evidence": "Not graded",
            "typical_time_to_judge_response": "Variable"
        },
        {
            "treatment": "Witch hazel",
            "availability": "Over the counter",
            "category": "Over-the-counter topical",
            "guideline_position": "Evidence judged insufficient",
            "certainty_of_evidence": "Not graded",
            "typical_time_to_judge_response": "Unclear"
        },
        {
            "treatment": "Azelaic acid for post-inflammatory hyperpigmentation",
            "availability": "OTC 10% and prescription 15–20%",
            "category": "Scars & marks",
            "guideline_position": "Not assessed in the guideline",
            "certainty_of_evidence": "Moderate",
            "typical_time_to_judge_response": "8–16 weeks"
        },
        {
            "treatment": "Fractional laser resurfacing for acne scars",
            "availability": "In clinic",
            "category": "Scars & marks",
            "guideline_position": "Not assessed in the guideline",
            "certainty_of_evidence": "Moderate",
            "typical_time_to_judge_response": "3–5 sessions; months of remodelling after"
        },
        {
            "treatment": "Sunscreen for post-inflammatory hyperpigmentation",
            "availability": "Over the counter",
            "category": "Scars & marks",
            "guideline_position": "Not assessed in the guideline",
            "certainty_of_evidence": "Moderate",
            "typical_time_to_judge_response": "Prevention; months to see the difference"
        },
        {
            "treatment": "Topical tretinoin for post-inflammatory hyperpigmentation",
            "availability": "Prescription",
            "category": "Scars & marks",
            "guideline_position": "Not assessed in the guideline",
            "certainty_of_evidence": "Moderate",
            "typical_time_to_judge_response": "10–40 weeks"
        },
        {
            "treatment": "Hydroquinone (with tretinoin and a steroid, Kligman-type)",
            "availability": "Prescription",
            "category": "Scars & marks",
            "guideline_position": "Not assessed in the guideline",
            "certainty_of_evidence": "Low",
            "typical_time_to_judge_response": "8–12 weeks, short-term use"
        },
        {
            "treatment": "Microneedling for atrophic acne scars",
            "availability": "In clinic",
            "category": "Scars & marks",
            "guideline_position": "Not assessed in the guideline",
            "certainty_of_evidence": "Low",
            "typical_time_to_judge_response": "3–6 sessions, months apart"
        },
        {
            "treatment": "Subcision for tethered (rolling) scars",
            "availability": "In clinic",
            "category": "Scars & marks",
            "guideline_position": "Not assessed in the guideline",
            "certainty_of_evidence": "Low",
            "typical_time_to_judge_response": "1–3 sessions"
        },
        {
            "treatment": "TCA CROSS for ice-pick scars",
            "availability": "In clinic",
            "category": "Scars & marks",
            "guideline_position": "Not assessed in the guideline",
            "certainty_of_evidence": "Very low",
            "typical_time_to_judge_response": "3–6 sessions, weeks apart"
        },
        {
            "treatment": "Clindamycin + adapalene + benzoyl peroxide (triple, Cabtreo)",
            "availability": "Prescription",
            "category": "Prescription topical",
            "guideline_position": "Not assessed in the guideline",
            "certainty_of_evidence": "Not graded",
            "typical_time_to_judge_response": "8–12 weeks"
        },
        {
            "treatment": "Hydrocolloid pimple patches",
            "availability": "Over the counter",
            "category": "Over-the-counter topical",
            "guideline_position": "Not assessed in the guideline",
            "certainty_of_evidence": "Not graded",
            "typical_time_to_judge_response": "6–24 hours per lesion"
        },
        {
            "treatment": "Moisturiser and broad-spectrum sunscreen",
            "availability": "Over the counter",
            "category": "Over-the-counter topical",
            "guideline_position": "Not assessed in the guideline",
            "certainty_of_evidence": "Not graded",
            "typical_time_to_judge_response": "Supportive, not curative"
        },
        {
            "treatment": "Pneumatic broadband light added to adapalene 0.3%",
            "availability": "In clinic",
            "category": "In-clinic procedure",
            "guideline_position": "Conditional recommendation AGAINST",
            "certainty_of_evidence": "Low",
            "typical_time_to_judge_response": "n/a"
        }
    ]
}