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.