The role of general practitioners in the management of patients with acne using isotretinoin: Protocol for a scoping review of clinical practice guidelines

Abstract

Background Acne is the most common inflammatory skin disease, affecting most teenagers and many adults. Acne imposes physical, psychological, social and fiscal burdens, with additional concerns around antimicrobial stewardship. Isotretinoin is the most effective treatment for severe acne. However, there are well-documented serious adverse effects with teratogenicity, impact on mental health and blood abnormalities of particular concern. The prescribing practice of isotretinoin varies substantially internationally. Some countries restrict isotretinoin prescribing solely to dermatologists, while other countries have guidance supporting GPs to prescribe isotretinoin as well. The existing literature lacks clarity around the important issue of who should prescribe isotretinoin and fails to describe the specific role of GPs in managing patients with acne using isotretinoin. This scoping review will address this evidence gap by examining the role of the GP in prescribing isotretinoin in acne clinical practice guidelines. Methods This scoping review adopts the Joanna Briggs Institute scoping review methodology with PRISMA extension for scoping reviews. The search strategy will interrogate medical databases and grey literature, and will also directly contact key stakeholders internationally, to identify clinical practice guidelines on the use of isotretinoin in acne from 2013 to May 2024. Two reviewers will independently review all citations, and full text of selected sources, against relevant inclusion-exclusion criteria. Appropriate data extraction tool(s) will be designed, piloted and refined, whereupon full data extraction will be undertaken. Results This scoping review will interrogate diverse evidence sources and distil the evidence base informing the role of GPs in prescribing isotretinoin for people with acne. Conclusion The strategic objective of this scoping review is to explore and illuminate the evidence around the role of GPs in prescribing isotretinoin when managing patients with acne.