Latest AAD Dermatology Guidelines
Atopic Dermatitis (2025 Update)
The AAD released a focused update in 2025 specifically recommending four new therapies for adult atopic dermatitis: tapinarof cream, roflumilast cream, lebrikizumab, and nemolizumab—all with strong recommendations when used with concomitant topical therapy 1.
New Strong Recommendations (2025)
The workgroup made strong recommendations for:
- Tapinarof cream (topical aryl hydrocarbon receptor modulator)
- Roflumilast cream (topical PDE-4 inhibitor)
- Lebrikizumab (biologic targeting IL-13)
- Nemolizumab (biologic targeting IL-31 receptor, specifically for pruritus)
All four agents should be used with concomitant topical therapy rather than as monotherapy 1.
Existing AD Treatment Algorithm (2023-2024)
The comprehensive AAD guidelines from 2023-2024 remain current and include:
Strong recommendations for:
- Nonprescription moisturizers (barrier restoration)
- Topical corticosteroids
- Topical calcineurin inhibitors (tacrolimus, pimecrolimus)
- Topical PDE-4 inhibitors (crisaborole, now including roflumilast)
- Topical JAK inhibitors (ruxolitinib) 2
Conditional recommendations for:
- Bathing and wet wrap therapy
- Against topical antimicrobials, antiseptics, and antihistamines as routine therapy 2
Acne Vulgaris (2024 Guidelines)
For acne management, the AAD strongly recommends topical benzoyl peroxide, retinoids, and/or antibiotics (including fixed-dose combinations) and oral doxycycline, with isotretinoin strongly recommended for severe acne, acne causing psychosocial burden or scarring, or acne failing standard therapy 3.
Treatment Algorithm by Severity
Mild Acne:
- Topical benzoyl peroxide (strong recommendation)
- Topical retinoids (adapalene, tretinoin, tazarotene, trifarotene) (strong recommendation)
- Fixed-dose combinations preferred over monotherapy 3
Moderate Acne:
- Fixed-dose combination: topical retinoid + benzoyl peroxide (strong recommendation)
- Fixed-dose combination: topical antibiotic + benzoyl peroxide (strong recommendation)
- Oral doxycycline if systemic therapy needed (strong recommendation)
- Never use topical antibiotic monotherapy (promotes resistance) 3
Moderate-to-Severe Acne:
- Oral doxycycline (strong recommendation over minocycline)
- Sarecycline (conditional recommendation)
- Minocycline (conditional recommendation)
- Always combine systemic antibiotics with benzoyl peroxide to prevent resistance 3
Severe Acne or Treatment-Resistant:
- Isotretinoin is the strong recommendation 3
- Patients with psychosocial burden or scarring should be considered candidates for isotretinoin regardless of clinical severity
- Daily dosing preferred over intermittent
- Monitor only liver function tests and lipids (CBC monitoring not needed in healthy patients)
- Population studies show no increased risk of neuropsychiatric conditions or inflammatory bowel disease 3
Hormonal Therapy (For Appropriate Patients)
- Combined oral contraceptives (conditional recommendation)
- Spironolactone (conditional recommendation)
- Potassium monitoring not needed in healthy patients without risk factors for hyperkalemia 3
Conditional Recommendations
- Topical clascoterone (first topical antiandrogen)
- Topical azelaic acid
- Topical salicylic acid 3
Good Practice Statements
- Use multimodal topical therapy combining multiple mechanisms of action
- Limit systemic antibiotic duration to reduce resistance
- Intralesional corticosteroids for larger papules/nodules at risk of scarring (use judiciously with lower concentrations) 3
Key Implementation Points
Critical Pitfalls to Avoid
For Atopic Dermatitis:
- Don't use topical antimicrobials, antiseptics, or antihistamines routinely (conditional recommendation against) 2
- The 2025 update emphasizes that new biologics and topicals should be used with (not instead of) concomitant topical therapy 1
For Acne:
- Never prescribe topical antibiotics alone—always combine with benzoyl peroxide 3
- Don't use systemic antibiotics long-term without benzoyl peroxide
- Don't delay isotretinoin in patients with scarring or psychosocial burden—these patients qualify as "severe" regardless of lesion count 3
- Azithromycin is inferior to doxycycline (conditional recommendation for doxycycline over azithromycin) 3
Strength of Evidence Context
These guidelines used the GRADE methodology, meaning "strong" recommendations indicate high confidence that benefits substantially outweigh harms, while "conditional" recommendations suggest closer balance or lower certainty of evidence. The 2025 AD update and 2024 acne guidelines represent the most current AAD positions, superseding 2014 recommendations 1, 3.