Competencies and clinical guidelines for managing acne with isotretinoin in general practice: a scoping review
Competencies and clinical guidelines for managing acne with isotretinoin in general practice: a scoping review
Background: acne is a common, chronic, and burdensome disease. There is evidence of delayed and inequitable patient access to isotretinoin. Overuse of antibiotics in patients with acne raises antimicrobial stewardship concerns.
Aim: to identify clinical practice guideline (CPG) and consensus statement recommendations regarding the clinical competencies required for prescribing oral isotretinoin for acne.
Design and setting: this was a scoping review of acne CPGs and consensus statements, globally.
Method: the Arksey and O’Malley framework informed design in conjunction with Joanna Briggs Institute guidance. The PRISMA extension for Scoping Reviews guided reporting. The search was conducted across six databases (Embase, Scopus, Web of Science, PubMed, CINAHL, PsycINFO), three guideline repositories (Scottish Intercollegiate Guidelines Network, Guidelines International Network, Trip), and grey literature. Two researchers independently screened titles and abstracts, and full-text papers. The AGREE II checklist appraised CPG quality.
Results: from the initial 2292 articles, eight CPGs were included after applying inclusion and exclusion criteria. Five were from Europe, with one each from the US, Canada, and Malaysia. The CPG guidance varied regarding 'Which doctor may prescribe isotretinoin?' All CPGs indicated dermatologists and four identified GPs as appropriate prescribers. The CPGs identify the clinical competencies to safely manage people with acne using isotretinoin: dermatology, pregnancy prevention, mental health assessment, and blood testing.
Conclusion: this scoping review has identified the key clinical competencies that underpin safe management of people with acne using isotretinoin: dermatology, pregnancy prevention, mental health assessment, and blood testing. Resourcing and supporting GPs to incrementally adopt this role may promote safe, timely, and equitable patient access to isotretinoin, while enhancing antimicrobial stewardship.
e597-e606
Quinlan, Diarmuid
0518c78e-7c6a-41dd-b038-98859cf41a67
Santer, Miriam
3ce7e832-31eb-4d27-9876-3a1cd7f381dc
Layton, Alison M.
5b851301-28e2-49f6-af30-a1bb7f35baa1
Quinlan, Diarmuid
0518c78e-7c6a-41dd-b038-98859cf41a67
Santer, Miriam
3ce7e832-31eb-4d27-9876-3a1cd7f381dc
Layton, Alison M.
5b851301-28e2-49f6-af30-a1bb7f35baa1
Quinlan, Diarmuid, Sahm, Laura, O’Keeffe, Linda, Santer, Miriam, Layton, Alison M. and Foley, Tony
(2025)
Competencies and clinical guidelines for managing acne with isotretinoin in general practice: a scoping review.
British Journal of General Practice, 75 (758), .
(doi:10.3399/BJGP.2025.0135).
Abstract
Background: acne is a common, chronic, and burdensome disease. There is evidence of delayed and inequitable patient access to isotretinoin. Overuse of antibiotics in patients with acne raises antimicrobial stewardship concerns.
Aim: to identify clinical practice guideline (CPG) and consensus statement recommendations regarding the clinical competencies required for prescribing oral isotretinoin for acne.
Design and setting: this was a scoping review of acne CPGs and consensus statements, globally.
Method: the Arksey and O’Malley framework informed design in conjunction with Joanna Briggs Institute guidance. The PRISMA extension for Scoping Reviews guided reporting. The search was conducted across six databases (Embase, Scopus, Web of Science, PubMed, CINAHL, PsycINFO), three guideline repositories (Scottish Intercollegiate Guidelines Network, Guidelines International Network, Trip), and grey literature. Two researchers independently screened titles and abstracts, and full-text papers. The AGREE II checklist appraised CPG quality.
Results: from the initial 2292 articles, eight CPGs were included after applying inclusion and exclusion criteria. Five were from Europe, with one each from the US, Canada, and Malaysia. The CPG guidance varied regarding 'Which doctor may prescribe isotretinoin?' All CPGs indicated dermatologists and four identified GPs as appropriate prescribers. The CPGs identify the clinical competencies to safely manage people with acne using isotretinoin: dermatology, pregnancy prevention, mental health assessment, and blood testing.
Conclusion: this scoping review has identified the key clinical competencies that underpin safe management of people with acne using isotretinoin: dermatology, pregnancy prevention, mental health assessment, and blood testing. Resourcing and supporting GPs to incrementally adopt this role may promote safe, timely, and equitable patient access to isotretinoin, while enhancing antimicrobial stewardship.
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Accepted/In Press date: 9 May 2025
e-pub ahead of print date: 28 August 2025
Identifiers
Local EPrints ID: 506742
URI: http://eprints.soton.ac.uk/id/eprint/506742
ISSN: 0960-1643
PURE UUID: c40c8826-7ee2-4ae4-ab0d-a81018e6807c
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Date deposited: 17 Nov 2025 17:52
Last modified: 18 Nov 2025 02:43
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Contributors
Author:
Diarmuid Quinlan
Author:
Laura Sahm
Author:
Linda O’Keeffe
Author:
Alison M. Layton
Author:
Tony Foley
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