The Management of Acne in General Practice using Isotretinoin: A Scoping Review Protocol

Shane Collins; Tony Foley; Diarmuid Quinlan; Emma Wallace; Laura Sahm; Aisling Farrell

doi:10.12688/hrbopenres.14215.1

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Study Protocol

The Management of Acne in General Practice using Isotretinoin: A Scoping Review Protocol

[version 1; peer review: 1 approved, 2 approved with reservations]

Shane Collins ¹, Tony Foley¹, Diarmuid Quinlan^1,2, Emma Wallace¹, Laura Sahm³, Aisling Farrell¹

Shane Collins ¹, Tony Foley¹, [...] Diarmuid Quinlan^1,2, Emma Wallace¹, Laura Sahm³, Aisling Farrell¹

PUBLISHED 26 Feb 2026

Author details Author details

¹ Department of General Practice, University College Cork School of Medicine, Cork, County Cork, Ireland
² Irish College of General Practitioners, Dublin, Ireland
³ Pharmaceutical Care Research Group, School of Pharmacy, University College Cork School of Medicine, Cork, County Cork, Ireland

Shane Collins
Roles: Conceptualization, Data Curation, Investigation, Methodology, Project Administration, Resources, Software, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Tony Foley
Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Diarmuid Quinlan
Roles: Methodology, Validation, Writing – Review & Editing

Emma Wallace
Roles: Writing – Review & Editing

Laura Sahm
Roles: Writing – Review & Editing

Aisling Farrell
Roles: Data Curation, Formal Analysis, Investigation, Methodology, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Introduction

Acne Vulgaris (Acne) is a common, chronic, cutaneous disorder associated with scarring, hyperpigmentation, and adverse psychological effects. The high prevalence of acne places a significant burden on healthcare systems worldwide due to the cost of treatment. The high usage of antibiotics in the treatment of this condition also has a significant impact on the prevalence of antimicrobial resistance. Isotretinoin is considered to be the most effective treatment for the management of severe acne; however, issues remain with inequitable access to this drug. General Practitioners (GPs) are ideally placed to identify and manage patients with moderate-to-severe acne; however, in many countries the prescription of isotretinoin is limited to secondary care. To the authors' knowledge, no review has been conducted to identify, map and analyse literature pertaining to GPs’ use of isotretinoin for the management of acne.

Methods

As recommended by the Joanna Briggs Institute (JBI), a three-step search strategy will be utilised for this scoping review. A search strategy will be developed using key words, search terms and controlled vocabulary suitable for each literature source. Both primary and grey literature will be eligible for inclusion in this review. Identified literature will be screened by two reviewers to identify relevant evidence. The full-text sources will then be evaluated by two independent researchers to extract relevant data. The findings of this review will be reported as a descriptive summary accompanied by a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.

Results

This scoping review protocol outlines a systematic approach to map a broad range of sources and summarise existing evidence regarding GPs’ use of isotretinoin for the management of acne in primary care.

Conclusions

The objective of this scoping review is to comprehensively identify, map, and analyse literature pertaining to the management of acne using isotretinoin in general practice.

Review registration

Registered on Open Science Framework on 02/10/2025 (https://osf.io/rak3d/)

Keywords

Acne, Acne Vulgaris, Primary Care, General Practitioners, Isotretinoin

Corresponding author: Shane Collins

Competing interests: No competing interests were disclosed.

Grant information: This research is supported by a research grant from the Health Service Executive South West.

Copyright: © 2026 Collins S et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Collins S, Foley T, Quinlan D et al. The Management of Acne in General Practice using Isotretinoin: A Scoping Review Protocol [version 1; peer review: 1 approved, 2 approved with reservations]. HRB Open Res 2026, 9:21 (https://doi.org/10.12688/hrbopenres.14215.1) First published: 26 Feb 2026, 9:21 (https://doi.org/10.12688/hrbopenres.14215.1) Latest published: 26 Feb 2026, 9:21 (https://doi.org/10.12688/hrbopenres.14215.1)

Introduction

Acne Vulgaris (Acne) is a common inflammatory disorder of the pilosebaceous unit that affects a large proportion of young people, with up to 85% of 12-24 year olds experiencing some degree of acne.^1,2 Although primarily seen in adolescence, it frequently persists into adulthood.^2,3 Acne is associated with a significant impact on patients’ quality of life, contributing to increased self-consciousness and decreased psychological well-being, highlighting the broader personal burden of this disease.⁴

Frequent and extended use of antibiotics in acne management has contributed to rising concerns over antimicrobial resistance, prompting current international guidelines to restrict antibiotic duration and encourage effective non-antibiotic therapeutic alternatives.^5–7

Management of acne is also resource-intensive within healthcare systems. Many patients require repeated consultations, prolonged treatment courses and ongoing follow-up, contributing to workload in primary care, where most acne management occurs.

Clinical severity of acne varies, and approximately 15-20% of adolescents experience severe acne.^8,9 Early and effective treatment is essential to reduce long-term complications, particularly permanent scarring, which can have lasting psychological and cosmetic consequences.^10–12 Oral isotretinoin is widely regarded as the most effective treatment for severe and antibiotic resistant acne.^13,14 However, isotretinoin prescription requires careful patient selection, counselling and monitoring due to its adverse effect profile, including the need to screen for mental health concerns and to monitor for teratogenic risks and blood dyscrasias throughout treatment.^15,16

Internationally, there is considerable variation regarding the prescribing of isotretinoin. In some countries, prescribing remains dermatologist-led, most notably in the UK and USA. In contrast, several healthcare systems, such as Canada, Netherlands, Norway and New Zealand, support General Practitioner (GP) led prescribing.^17–21 These differences reflect broader variation in national clinical pathways and distribution of prescribing responsibilities.

In Ireland, there are no current guidelines on prescribing isotretinoin in general practice. Moreover, no formal shared care protocols with specialist dermatology services or quality-improvement processes exist for GPs who prescribe isotretinoin. Prescribing is therefore largely dependent on individual GPs with an interest in dermatology opting to prescribe.¹⁷ This lack of structured approach between primary and secondary care may lead to variation in clinical practice, potential gaps in safety monitoring and in the equity of access, particularly for females of childbearing potential.

Given their expertise in contraceptive management, mental health support and ability to provide continuity of care, GPs are well-positioned to prescribe and monitor isotretinoin.¹⁷

Despite this, limited literature exists that explores the GP’s use of isotretinoin for acne in primary care.^17,22

Emerging evidence suggests that while a proportion of GPs are willing to initiate isotretinoin, prescribing practices vary widely. Studies report that GPs often prescribe isotretinoin due to long dermatology waiting lists or personal interest in dermatology.^17,19 However, significant gaps in knowledge and confidence remain with many GPs unfamiliar with guidelines, uncertain about safe monitoring or concerned about medicolegal and teratogenic risks.^17,19 These studies also highlight suboptimal monitoring practices and inconsistent approaches to topical and antibiotic management.^17,23 Nonetheless, a substantial proportion of GPs express interest in prescribing isotretinoin if supported by clearer guidelines and specialist input.¹⁷

No review to date has provided a comprehensive synthesis of this disparate evidence to clarify the extent of these attitudes, barriers, behaviours, and practice variations across primary care settings.

A search of Google Scholar, JBI Evidence Synthesis, The Cochrane Database of Systematic Reviews, The Campbell Collaboration, PubMed and PROSPERO identified no existing or ongoing systematic or scoping reviews on this topic. This scoping review will therefore collate and map the available evidence on GP attitudes, practices, and challenges in prescribing isotretinoin in primary care.

Review questions

What is known about GP’s roles, experiences, and practices in using isotretinoin for acne in primary care?

This scoping review aims to complete the following review objectives:

1. To map the existing literature describing how GPs prescribe, monitor, and manage isotretinoin in primary care.
2. To examine GPs’ views, knowledge, and perceptions regarding isotretinoin use for acne.
3. To identify challenges, safety concerns, training needs, and systemic factors affecting GP prescribing.

Inclusion criteria

Population:

This review will consider all studies exploring GPs’ use of isotretinoin for the management of acne. GPs include primary care doctors and family medicine physicians.

Concept:

This scoping review will examine both peer reviewed and grey literature exploring the GP’s use of isotretinoin for the management of acne. Studies focusing on other acne treatments, or isotretinoin prescribed exclusively in secondary care, or for other conditions, will be excluded.

Context:

This review will consider literature examining isotretinoin use for acne for all patients in the primary care setting. Studies examining interventions in secondary care settings or interventions undertaken by physicians other than general practitioners will be excluded.

Types of sources:

This scoping review will consider peer reviewed qualitative, quantitative, and mixed-methods studies as well as grey literature. Studies published in any language will be included in this review.

Inclusion/Exclusion criteria summary:

A summary of the inclusion/exclusion criteria for this scoping review is available in Table 1 below.

Table 1. Inclusion/Exclusion criteria.

Inclusion

Exclusion

Population

• Literature examining patients with acne in primary care settings

• Literature examining patients with acne in primary care by physicians other than GPs

Intervention

• Peer reviewed and grey literature examining isotretinoin for the management of acne

• Literature examining isotretinoin for the treatment of conditions other than acne
• Literature examining interventions other than isotretinoin for the treatment of acne

Study Design

• All types of study design

• Incomplete trials (No results)
• Duplicate publications of the same study that do not report on different outcomes

Study Characteristics

• All geographical regions and languages
• No date restrictions

• None

Methods

Search strategy

As recommended by the JBI Manual for Evidence Synthesis 2024, a three-step search strategy was developed by the authors to locate all relevant literature that meets the threshold for inclusion in this review.²⁴ As part of this search strategy, an initial limited search using the MEDLINE (PubMed) database was performed. (01/10/2025) This initial search strategy, and all keywords used in this initial search, are included in Table 2 of this protocol. This initial search will be followed by a full search using identified key words and index terms in the subsequent comprehensive scoping review. This search strategy will be adapted to include index terms for each database included in the review. Finally, the reference lists of all included sources will be examined to identify any additional relevant literature.²⁴

Table 2. Search strategy: PubMed. Search undertaken on 01/10/2025.

Search	Terms	Results
#1	"Acne Vulgaris"[MeSH Terms] OR "Acne Vulgaris"[Title/Abstract] OR "Acne"[Title/Abstract]	24,730
#2	"general p"[Title/Abstract] OR "gp"[Title/Abstract] OR "primary care"[Title/Abstract] OR "primary healthcare"[Title/Abstract] OR "family p"[Title/Abstract] OR "General Practitioners"[MeSH Terms] OR "General Practice"[MeSH Terms] OR "Family Practice"[MeSH Terms] OR "Primary Health Care"[MeSH Terms] OR "physicians, primary care"[MeSH Terms]	808,124
#3	#1 AND #2	852

Relevant grey literature will be identified for inclusion in the review with the use of Google Scholar and Web of Science. The first 100 results from each source will be collated for inclusion in the review.

Following the identification of all relevant keywords, search terms, and controlled vocabulary, the search strategy will be finalised with the assistance of a university librarian and applied uniformly across all literature sources included in this review. This search strategy, and any variations, will be documented and reported in full in the final scoping review.

No language or date restrictions will apply to studies being considered for inclusion in this review. Google Translate will be used to translate any articles written in languages other than English.

The databases to be searched include MEDLINE (Ovid), CINAHL Plus with Full Text, APA PsycINFO, Scopus, Cochrane Library, and EMBASE. These databases were selected for their comprehensive coverage of medical, nursing, psychological, and pharmacological literature, ensuring a broad retrieval of relevant studies.

Study selection

Following the completion of our search strategy, all identified abstracts will be collated and uploaded into Rayyan and duplicate citations removed.²⁵ The title and abstract of each study will be screened by two independent reviewers (SC, AF) for assessment against the inclusion criteria of this review. Relevant citations will be retrieved in full, and their full text will be assessed in detail against the inclusion criteria by the two independent reviewers. Reasons for the exclusion of sources of evidence at full text that do not meet inclusion criteria will be reported in the scoping review.

Any disagreements that arise between the reviewers at each stage of the selection process will be discussed and if necessary, resolved by a third reviewer (TF). The results of the search and the study inclusion process will be reported in full in the final scoping review and presented in a PRISMA flow diagram.²⁶

Data extraction

Data will be extracted from papers included in the scoping review using a data extraction tool developed by the reviewers. Key information such as author(s), year of publication, journal, and results, or findings relevant to the review questions will be extracted using this tool. A draft data extraction tool is provided in Appendix B.

It is likely that the data extraction tool will be modified in an iterative fashion during the course of the review. Any modifications to the data extraction tool will be detailed in the scoping review. Any disagreements that arise between the reviewers will be resolved by discussion. If necessary, authors of papers will be directly contacted to request missing or additional data.

Data analysis and results

Data gathered by this scoping review will be presented in table and figure format. Data such as the number of publications, study designs, year of publication, and country of origin will be analysed and presented. A descriptive summary which describes how the results relate to the review objectives and questions will accompany the results. As data analysis and presentation is an iterative process additional information that is relevant to the review objectives may be identified and included in the review, any deviations from the protocol such as this will be clearly identified in the scoping review.

Data availability

Open Science Framework: The General Practitioner’s Perspective on Isotretinoin for the Management of Acne Vulgaris in Primary Care: A Scoping Review Protocol. https://doi.org/10.17605/OSF.IO/SZKTB.²⁷

This project contains the following extended data:

• Appendix B - Draft Data Extraction Tool.xlsx. (Blank English version of the draft data extraction tool)

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Acknowledgements

We gratefully acknowledge the expertise and assistance of Ben Williamson, Learning and Teaching Librarian, and Siobhan Bowman, Learning Support Librarian, University College Cork, for their support in developing and refining the search strategy.

References

1. Chen H, Zhang TC, Yin XL, et al.: Magnitude and temporal trend of acne vulgaris burden in 204 countries and territories from 1990 to 2019: an analysis from the Global Burden of Disease Study 2019. Br. J. Dermatol. 2022 [cited 2025 Jun 12]; 186(4): 673–683. PubMed Abstract | Publisher Full Text
2. Bhate K, Williams HC: Epidemiology of acne vulgaris. Br. J. Dermatol. 2013; 168: 474–485. PubMed Abstract | Publisher Full Text
3. Zha M, Usatine R: Common Skin Conditions in Children and Adolescents: Acne. FP essentials. 2024; 541: 7–13.PubMed Abstract
4. Zouboulis CC, Dessinioti C, Antoniou C: Acne Epidemiology and Socioeconomic Aspects.Zouboulis CC, Katsambas AD, Kligman AM, editors. Pathogenesis and Treatment of Acne and Rosacea. Berlin, Heidelberg: Springer; 2014 [cited 2025 Jun 12]; pp. 53–57. Publisher Full Text
5. Dessinioti C, Katsambas A: Antibiotics and Antimicrobial Resistance in Acne: Epidemiological Trends and Clinical Practice Considerations. Yale J. Biol. Med. 2022 Dec 22 [cited 2025 Jun 15]; 95(4): 429–443. PubMed Abstract Reference Source
6. Karadag A, Aslan Kayıran M, Wu CY, et al.: Antibiotic resistance in acne: changes, consequences and concerns. J. Eur. Acad. Dermatol. Venereol. 2021 [cited 2024 Oct 4]; 35(1): 73–78. PubMed Abstract | Publisher Full Text
7. Reynolds RV, Yeung H, Cheng CE, et al.: Guidelines of care for the management of acne vulgaris. J. Am. Acad. Dermatol. 2024 May 1; 90(5): 1006.e1–1006.e30. PubMed Abstract | Publisher Full Text Reference Source
8. Recommendations|Acne vulgaris: management|Guidance|NICE. NICE; 2021 [cited 2025 Jun 14]. Reference Source
9. Silverberg JI, Silverberg NB: Epidemiology and extracutaneous comorbidities of severe acne in adolescence: a U.S. population-based study. Br. J. Dermatol. 2014 May 1 [cited 2024 Oct 4]; 170(5): 1136–1142. PubMed Abstract | Publisher Full Text
10. Layton AM, Cunliffe WJ: Guidelines for optimal use of isotretinoin in acne. J. Am. Acad. Dermatol. 1992; 27(6 Pt 2): S2–S7. PubMed Abstract | Publisher Full Text
11. Layton AM, Seukeran D, Cunliffe WJ: Scarred for life?. Dermatology (Basel). 1997; 195(1): 15–21. PubMed Abstract | Publisher Full Text
12. Layton AM: Optimal management of acne to prevent scarring and psychological sequelae. Am. J. Clin. Dermatol. 2001; 2(3): 135–141. PubMed Abstract | Publisher Full Text
13. Layton A: The use of isotretinoin in acne. Dermatoendocrinol. 2009 [cited 2024 Oct 4]; 1(3): 162–169. PubMed Abstract | Publisher Full Text Reference Source
14. Huang CY, Chang IJ, Bolick N, et al.: Comparative Efficacy of Pharmacological Treatments for Acne Vulgaris: A Network Meta-Analysis of 221 Randomized Controlled Trials. Ann. Fam. Med. 2023 Jul 1 [cited 2025 Jun 14]; 21(4): 358–369. PubMed Abstract | Publisher Full Text Reference Source
15. Goldsmith LA, Bolognia JL, Callen JP: American Academy of Dermatology et al. American Academy of Dermatology Consensus Conference on the safe and optimal use of isotretinoin: summary and recommendations. J. Am. Acad. Dermatol. 2004; 50(6): 900–906. PubMed Abstract | Publisher Full Text
16. Acne vulgaris: management: National Institute for Health and Care Excellence (NICE).2023.
17. Carmody K, Rouse M, Nolan D, et al.: GPs’ practice and attitudes to initiating isotretinoin for acne vulgaris in Ireland: a cross-sectional questionnaire survey in primary care. Br. J. Gen. Pract. 2020 Sept; 70(698): e651–e656. Publisher Full Text
18. Acne|NHG-Richtlijnen: [cited 2025 July 23]. Reference Source
19. Hosseinpour P, Gholamabbas G, Pezeshkian F, et al.: Practice and attitude of general practitioners towards initiating isotretinoin for acne vulgaris in Fars province, Iran: cross-sectional study. BMC Prim. Care. 2024 Jan 13; 25(1): 27. PubMed Abstract | Publisher Full Text
20. Christiansen CS, Høye S, Lindbaek M, et al.: Acne management in Norway: general practitioner and dermatologist prescriptions (2012-2019), a nationwide overview. BJGP Open. 2025 May 20 [cited 2025 Aug 19]; 9: BJGPO.2024.0211. PubMed Abstract | Publisher Full Text | Free Full Text
21. Moodie P, Roskvist RP, Arnold J, et al.: Widening access to isotretinoin in primary care: an evaluation of New Zealand national dispensing data for isotretinoin for acne, 2008-2023. BMJ Open. 2025 Jan 28; 15(1): e093572. PubMed Abstract | Publisher Full Text
22. Quinlan D, Sahm LJ, O’Keeffe L, et al.: Competencies and clinical guidelines for managing acne with isotretinoin in general practice: A scoping review. Br. J. Gen. Pract. 2025 Jun 23 [cited 2025 Jul 7]. Reference Source
23. Platt D, Muller I, Sufraz A, et al.: GPs’ perspectives on acne management in primary care: a qualitative interview study. Br. J. Gen. Pract. 2021 Jan; 71(702): e78–e84. PubMed Abstract | Publisher Full Text
24. Aromataris E, Lockwood C, Porritt K, et al.: JBI Manual for Evidence Synthesis. JBI; 2024 [cited 2024 Sep 24]. Reference Source
25. Ouzzani M, Hammady H, Fedorowicz Z, et al.: Rayyan—a web and mobile app for systematic reviews. Syst. Rev. 2016 Dec 5 [cited 2025 Jun 14]; 5(1): 210. PubMed Abstract | Publisher Full Text | Free Full Text
26. Page MJ, McKenzie JE, Bossuyt PM, et al.: The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021 Mar 29 [cited 2024 Sep 24]; 372: n71. Publisher Full Text Reference Source
27. Collins S: The General Practitioner’s Perspective on Isotretinoin for the Management of Acne Vulgaris in Primary Care: A Scoping Review Protocol [Document]. OSF. 2025 [cited 2026 Jan 22]. Publisher Full Text

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Version 1

VERSION 1 PUBLISHED 26 Feb 2026

Author details Author details

¹ Department of General Practice, University College Cork School of Medicine, Cork, County Cork, Ireland
² Irish College of General Practitioners, Dublin, Ireland
³ Pharmaceutical Care Research Group, School of Pharmacy, University College Cork School of Medicine, Cork, County Cork, Ireland

Shane Collins
Roles: Conceptualization, Data Curation, Investigation, Methodology, Project Administration, Resources, Software, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Tony Foley
Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Diarmuid Quinlan
Roles: Methodology, Validation, Writing – Review & Editing

Emma Wallace
Roles: Writing – Review & Editing

Laura Sahm
Roles: Writing – Review & Editing

Aisling Farrell
Roles: Data Curation, Formal Analysis, Investigation, Methodology, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

This research is supported by a research grant from the Health Service Executive South West.

Article Versions (1)

version 1

Published: 26 Feb 2026, 9:21

https://doi.org/10.12688/hrbopenres.14215.1

Copyright

© 2026 Collins S et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Collins S, Foley T, Quinlan D et al. The Management of Acne in General Practice using Isotretinoin: A Scoping Review Protocol [version 1; peer review: 1 approved, 2 approved with reservations]. HRB Open Res 2026, 9:21 (https://doi.org/10.12688/hrbopenres.14215.1)

NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.

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Key to Reviewer Statuses VIEW HIDE

ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions

Version 1

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Reviewer Report 05 Jun 2026

Anneliese Willems, University of Melbourne, Melbourne, Australia

Approved

https://doi.org/10.21956/hrbopenres.15633.r53862

Thank you for the opportunity to review this protocol. It is a clear and well-structured submission addressing an important clinical question.

I have provided my comments below in dot-points to aid with readability:

Overall ... Continue reading

Thank you for the opportunity to review this protocol. It is a clear and well-structured submission addressing an important clinical question.

I have provided my comments below in dot-points to aid with readability:

Overall comments:

It is a clear protocol addressing an important clinical question
The rationale and objectives are well articulated, and the use of a scoping review methodology is appropriate given the heterogeneity of the literature.

Major comments:

Strength of key claim regarding GP capability
- The statement: “Given their expertise in contraceptive management, mental health support and ability to provide continuity of care, GPs are well-positioned to prescribe and monitor isotretinoin” (ref 17) appears stronger than the supporting evidence
- The cited study demonstrates GP interest and identifies enablers, but also highlights variability in practice and gaps in monitoring and contraceptive management
- Consider moderating this statement or supporting it with additional evidence
Definition and scope of grey literature
- While the protocol states that grey literature will be included, it does not define what will be considered eligible
- Given the heterogeneity and variable quality of grey literature, this lack of definition may introduce inconsistency and selection bias
- Clarification is needed regarding:
  - Types of grey literature to be included (e.g. guidelines, policy documents, organisational reports, conference abstracts, theses, tiktoks, podcasts reels, social media etc)
  - Any limits on source type, quality, or jurisdiction
Grey literature search strategy
- The approach of including the “first 100 results” from Google Scholar and Web of Science is not sufficiently justified
- Search engine ranking algorithms are not transparent or reproducible (to my understanding), which may introduce bias
- Consider:
  - Providing a rationale for this cutoff
  - Supplementing with targeted grey literature sources (e.g. guideline repositories, professional bodies)
Data extraction methodology
- The data extraction process is described at a high level, but could be expanded to improve reproducibility
- In particular, it would be helpful to specify:
  - Whether the extraction tool will be piloted
  - How consistency between reviewers will be ensured (e.g. double extraction of a subset)
  - How disagreements will be handled beyond discussion
- Consider whether a systematic review platform (e.g. Covidence or similar) will be used to support data management, noting that this is a scoping review but these platforms may still have a place in streamlining screening.

Minor comments / suggestions:

Referencing style
- There appears to be consistent over-referencing throughout (e.g. multiple references per sentence where not required) - this can reduce readability and may not add additional value
- Consider streamlining references to key supporting sources
Population definition
- The protocol focuses on GPs, but it is unclear whether GP registrars/trainees will be included - clarifying inclusion of trainees may be important, particularly as they may represent a distinct group in terms of prescribing practices and confidence
Research team description
- Affiliations and roles are provided, but the disciplinary backgrounds of the authors are not explicitly described
- Given the interpretive nature of scoping reviews, outlining the perspectives represented (e.g. general practice, pharmacy) would enhance transparency and help contextualise interpretation
Terminology / consistency
- The protocol alternates between “GPs”, “general practitioners”, “primary care doctors”, and “family medicine physicians”. This is reasonable, but it may help to define these terms more clearly at the outset and state how international variations in role/title will be handled during screening and synthesis.
Potential overlap with existing review
- Reference 22 is cited as a scoping review on competencies and clinical guidelines for managing acne with isotretinoin in general practice. It may be worth clarifying more explicitly how the present review differs from that work.
Conceptual boundaries
- It would be helpful to clarify whether this review is focused only on GP initiation of isotretinoin, or whether it also includes shared care, continuation prescribing, and monitoring undertaken in primary care after non-GP specialist initiation. These are distinct models of care and may affect interpretation of findings.
No date restrictions
- Inclusion of studies without date restriction is defensible, but older isotretinoin literature may reflect substantially different prescribing rules and monitoring practices. The authors may wish to comment on how temporal changes in practice will be considered during synthesis.

Optional idea:

The authors may wish to briefly outline how they will approach synthesis of heterogeneous evidence, particularly given the inclusion of both peer-reviewed and grey literature
- For example, whether findings will be grouped by theme (e.g. attitudes, barriers, prescribing practices, system factors)

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Partly
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests: I am a General Practitioner and academic with a clinical and research focus in dermatology and primary care prescribing, including involvement in advisory work related to isotretinoin policy. I have no direct involvement in this study and no financial competing interests.

Reviewer Expertise: General practice, dermatology, clinical education, and primary care health systems. Experienced in qualitative research and scoping review methodology.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Reviewer Report 25 Apr 2026

Cathrine Strom Christiansen, University of Oslo, Oslo, Norway

Approved with Reservations

https://doi.org/10.21956/hrbopenres.15633.r54465

The Management of Acne in General Practice using Isotretinoin: A Scoping Review Protocol
Thank you for the opportunity to review this scoping review protocol. Acne is a common topic in general practice, and I appreciate that the authors have ... Continue reading

The Management of Acne in General Practice using Isotretinoin: A Scoping Review Protocol
Thank you for the opportunity to review this scoping review protocol. Acne is a common topic in general practice, and I appreciate that the authors have chosen to address it. This scoping review is timely in light of increasing antimicrobial resistance (AMR) and therefore the need for non-antibiotic treatment, and familiar inequity in access for isotretinoin for patients.

Overall, I find the protocol clear, well written, and easy to follow, with good flow. It adheres to the recommendations in the JBI Manual for Evidence Synthesis (2024) and other guidance on scoping reviews as a method.

It appears that a scoping review is an appropriate choice here. However, I wonder if the authors could make an argument for why a scoping review is preferred over a systematic review. Is the present scoping review intended as a precursor to a later systematic review? Clarifying this rationale would strengthen the methodological justification.

The tables are well structured and easy to understand.

In the Introduction, I would suggest adding a reference in the third paragraph to support the statement that patients with acne are primarily managed in primary care.

In the Inclusion criteria section, the descriptions of “Concept” and “Context” are generally good, but the reader must pay close attention not to interpret the second sentence of each paragraph as essentially saying the same thing. It may be helpful to rephrase these parts to more clearly highlight the differences between “Concept” and “Context.” I would also suggest defining the term “grey literature” the first time it is used, as not all readers will be familiar with this concept.

In the Methods and search strategy section, the initial search in the three-step search strategy is described as having been conducted in MEDLINE, i.e. a single database. According to the JBI Manual for Evidence Synthesis (2024), the initial search should preferably be conducted in at least two databases. It is possible that the authors plan to include additional databases in the actual scoping review, but this is not clearly stated. I recommend clarifying this point and, if only one database is to be used initially, providing a brief justification.

In the third paragraph of the Search strategy section, the authors state: “Following the identification of all relevant keywords, search terms, and controlled vocabulary, the search strategy will be finalised (…). This search strategy, and any variations, will be documented and reported in full in the final scoping review.” The fact that the search strategy is not fully finalised before the review starts opens up a potential for selection bias. This may be less problematic in a scoping review than in a systematic review, but it would be helpful if the authors briefly acknowledged and commented on this in the protocol.

I would prefer that the draft data extraction tool was described in more detail in the protocol. One option would be to develop Appendix B into a table that could also be as a table in the final article, rather than only as an appendix. My impression is that there is substantial additional information in the draft data extraction tool that is not currently reflected in the manuscript. This could be described more fully under the “Data extraction” section, particularly after the phrase “findings relevant to the review questions.”

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: My area of expertise is acne management in general practice and registry-based studies.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Reviewer Report 06 Mar 2026

Weeratian Tawanwongsri, Walailak University, Nakhon Si Thammarat, Thailand

Approved with Reservations

https://doi.org/10.21956/hrbopenres.15633.r53861

1. Introduction: The content is disjointed, with limited linkage between paragraphs. The narrative also shifts back and forth among prevalence, management, and prognosis. The authors should consider restructuring the section to flow from background information to current knowledge, then to ... Continue reading

1. Introduction: The content is disjointed, with limited linkage between paragraphs. The narrative also shifts back and forth among prevalence, management, and prognosis. The authors should consider restructuring the section to flow from background information to current knowledge, then to the identified knowledge gap, and finally to the study aim.
2.1 Methods: Some study designs should be excluded, including case reports, case series, and review articles.
2.2 There is a mismatch between the stated review focus and the population definition in Table 1. The protocol repeatedly frames the review as mapping GPs’ use of isotretinoin (clinician attitudes/practices), but Table 1 defines the “Population” as patients with acne in primary care settings, which does not align with the intended unit of analysis (GPs/practice-level evidence).
2.3 In the data extraction section, the authors may revise the extracted items to align with the stated objectives.
2.4 The search strategy (Table 2) does not include any isotretinoin-related terms.
2.5 Web of Science should not be described as “grey literature”; it should be listed under bibliographic databases.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Partly

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Dermatology, Internal Medicine

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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VERSION 1 PUBLISHED 26 Feb 2026

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Weeratian Tawanwongsri, Walailak University, Nakhon Si Thammarat, Thailand
Cathrine Strom Christiansen, University of Oslo, Oslo, Norway
Anneliese Willems, University of Melbourne, Melbourne, Australia

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05 Jun 2026 | for Version 1

Anneliese Willems, University of Melbourne, Melbourne, Australia

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Approved

Thank you for the opportunity to review this protocol. It is a clear and well-structured submission addressing an important clinical question.

I have provided my comments below in dot-points to aid with readability:

Overall comments:

It is a clear protocol addressing an important clinical question
The rationale and objectives are well articulated, and the use of a scoping review methodology is appropriate given the heterogeneity of the literature.

Major comments:

Strength of key claim regarding GP capability
- The statement: “Given their expertise in contraceptive management, mental health support and ability to provide continuity of care, GPs are well-positioned to prescribe and monitor isotretinoin” (ref 17) appears stronger than the supporting evidence
- The cited study demonstrates GP interest and identifies enablers, but also highlights variability in practice and gaps in monitoring and contraceptive management
- Consider moderating this statement or supporting it with additional evidence
Definition and scope of grey literature
- While the protocol states that grey literature will be included, it does not define what will be considered eligible
- Given the heterogeneity and variable quality of grey literature, this lack of definition may introduce inconsistency and selection bias
- Clarification is needed regarding:
  - Types of grey literature to be included (e.g. guidelines, policy documents, organisational reports, conference abstracts, theses, tiktoks, podcasts reels, social media etc)
  - Any limits on source type, quality, or jurisdiction
Grey literature search strategy
- The approach of including the “first 100 results” from Google Scholar and Web of Science is not sufficiently justified
- Search engine ranking algorithms are not transparent or reproducible (to my understanding), which may introduce bias
- Consider:
  - Providing a rationale for this cutoff
  - Supplementing with targeted grey literature sources (e.g. guideline repositories, professional bodies)
Data extraction methodology
- The data extraction process is described at a high level, but could be expanded to improve reproducibility
- In particular, it would be helpful to specify:
  - Whether the extraction tool will be piloted
  - How consistency between reviewers will be ensured (e.g. double extraction of a subset)
  - How disagreements will be handled beyond discussion
- Consider whether a systematic review platform (e.g. Covidence or similar) will be used to support data management, noting that this is a scoping review but these platforms may still have a place in streamlining screening.

Minor comments / suggestions:

Referencing style
- There appears to be consistent over-referencing throughout (e.g. multiple references per sentence where not required) - this can reduce readability and may not add additional value
- Consider streamlining references to key supporting sources
Population definition
- The protocol focuses on GPs, but it is unclear whether GP registrars/trainees will be included - clarifying inclusion of trainees may be important, particularly as they may represent a distinct group in terms of prescribing practices and confidence
Research team description
- Affiliations and roles are provided, but the disciplinary backgrounds of the authors are not explicitly described
- Given the interpretive nature of scoping reviews, outlining the perspectives represented (e.g. general practice, pharmacy) would enhance transparency and help contextualise interpretation
Terminology / consistency
- The protocol alternates between “GPs”, “general practitioners”, “primary care doctors”, and “family medicine physicians”. This is reasonable, but it may help to define these terms more clearly at the outset and state how international variations in role/title will be handled during screening and synthesis.
Potential overlap with existing review
- Reference 22 is cited as a scoping review on competencies and clinical guidelines for managing acne with isotretinoin in general practice. It may be worth clarifying more explicitly how the present review differs from that work.
Conceptual boundaries
- It would be helpful to clarify whether this review is focused only on GP initiation of isotretinoin, or whether it also includes shared care, continuation prescribing, and monitoring undertaken in primary care after non-GP specialist initiation. These are distinct models of care and may affect interpretation of findings.
No date restrictions
- Inclusion of studies without date restriction is defensible, but older isotretinoin literature may reflect substantially different prescribing rules and monitoring practices. The authors may wish to comment on how temporal changes in practice will be considered during synthesis.

Optional idea:

The authors may wish to briefly outline how they will approach synthesis of heterogeneous evidence, particularly given the inclusion of both peer-reviewed and grey literature
- For example, whether findings will be grouped by theme (e.g. attitudes, barriers, prescribing practices, system factors)

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Partly
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests

I am a General Practitioner and academic with a clinical and research focus in dermatology and primary care prescribing, including involvement in advisory work related to isotretinoin policy. I have no direct involvement in this study and no financial competing interests.

Reviewer Expertise

General practice, dermatology, clinical education, and primary care health systems. Experienced in qualitative research and scoping review methodology.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Reviewer Report

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25 Apr 2026 | for Version 1

Cathrine Strom Christiansen, University of Oslo, Oslo, Norway

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Approved With Reservations

The Management of Acne in General Practice using Isotretinoin: A Scoping Review Protocol
Thank you for the opportunity to review this scoping review protocol. Acne is a common topic in general practice, and I appreciate that the authors have chosen to address it. This scoping review is timely in light of increasing antimicrobial resistance (AMR) and therefore the need for non-antibiotic treatment, and familiar inequity in access for isotretinoin for patients.

Overall, I find the protocol clear, well written, and easy to follow, with good flow. It adheres to the recommendations in the JBI Manual for Evidence Synthesis (2024) and other guidance on scoping reviews as a method.

It appears that a scoping review is an appropriate choice here. However, I wonder if the authors could make an argument for why a scoping review is preferred over a systematic review. Is the present scoping review intended as a precursor to a later systematic review? Clarifying this rationale would strengthen the methodological justification.

The tables are well structured and easy to understand.

In the Introduction, I would suggest adding a reference in the third paragraph to support the statement that patients with acne are primarily managed in primary care.

In the Inclusion criteria section, the descriptions of “Concept” and “Context” are generally good, but the reader must pay close attention not to interpret the second sentence of each paragraph as essentially saying the same thing. It may be helpful to rephrase these parts to more clearly highlight the differences between “Concept” and “Context.” I would also suggest defining the term “grey literature” the first time it is used, as not all readers will be familiar with this concept.

In the Methods and search strategy section, the initial search in the three-step search strategy is described as having been conducted in MEDLINE, i.e. a single database. According to the JBI Manual for Evidence Synthesis (2024), the initial search should preferably be conducted in at least two databases. It is possible that the authors plan to include additional databases in the actual scoping review, but this is not clearly stated. I recommend clarifying this point and, if only one database is to be used initially, providing a brief justification.

In the third paragraph of the Search strategy section, the authors state: “Following the identification of all relevant keywords, search terms, and controlled vocabulary, the search strategy will be finalised (…). This search strategy, and any variations, will be documented and reported in full in the final scoping review.” The fact that the search strategy is not fully finalised before the review starts opens up a potential for selection bias. This may be less problematic in a scoping review than in a systematic review, but it would be helpful if the authors briefly acknowledged and commented on this in the protocol.

I would prefer that the draft data extraction tool was described in more detail in the protocol. One option would be to develop Appendix B into a table that could also be as a table in the final article, rather than only as an appendix. My impression is that there is substantial additional information in the draft data extraction tool that is not currently reflected in the manuscript. This could be described more fully under the “Data extraction” section, particularly after the phrase “findings relevant to the review questions.”

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Yes
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

My area of expertise is acne management in general practice and registry-based studies.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

Respond to this report

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Reviewer Report

9 Views

06 Mar 2026 | for Version 1

Weeratian Tawanwongsri, Walailak University, Nakhon Si Thammarat, Thailand

9 Views Cite this report Responses(0)

Approved With Reservations

1. Introduction: The content is disjointed, with limited linkage between paragraphs. The narrative also shifts back and forth among prevalence, management, and prognosis. The authors should consider restructuring the section to flow from background information to current knowledge, then to the identified knowledge gap, and finally to the study aim.
2.1 Methods: Some study designs should be excluded, including case reports, case series, and review articles.
2.2 There is a mismatch between the stated review focus and the population definition in Table 1. The protocol repeatedly frames the review as mapping GPs’ use of isotretinoin (clinician attitudes/practices), but Table 1 defines the “Population” as patients with acne in primary care settings, which does not align with the intended unit of analysis (GPs/practice-level evidence).
2.3 In the data extraction section, the authors may revise the extracted items to align with the stated objectives.
2.4 The search strategy (Table 2) does not include any isotretinoin-related terms.
2.5 Web of Science should not be described as “grey literature”; it should be listed under bibliographic databases.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Partly

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Dermatology, Internal Medicine

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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[1] 1. Chen H, Zhang TC, Yin XL, et al.: Magnitude and temporal trend of acne vulgaris burden in 204 countries and territories from 1990 to 2019: an analysis from the Global Burden of Disease Study 2019. Br. J. Dermatol. 2022 [cited 2025 Jun 12]; 186(4): 673–683. PubMed Abstract | Publisher Full Text

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[15] 15. Goldsmith LA, Bolognia JL, Callen JP: American Academy of Dermatology et al. American Academy of Dermatology Consensus Conference on the safe and optimal use of isotretinoin: summary and recommendations. J. Am. Acad. Dermatol. 2004; 50(6): 900–906. PubMed Abstract | Publisher Full Text

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The Management of Acne in General Practice using Isotretinoin: A Scoping Review Protocol

Abstract

Introduction

Methods

Results

Conclusions

Review registration

Keywords

Introduction

Review questions

Inclusion criteria

Table 1. Inclusion/Exclusion criteria.

Methods

Search strategy

Table 2. Search strategy: PubMed. Search undertaken on 01/10/2025.

Study selection

Data extraction

Data analysis and results

Data availability

Acknowledgements

References

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The Management of Acne in General Practice using Isotretinoin: A Scoping Review Protocol

Abstract

Introduction

Methods

Results

Conclusions

Review registration

Keywords

Introduction

Review questions

Inclusion criteria

Table 1. Inclusion/Exclusion criteria.

Methods

Search strategy

Table 2. Search strategy: PubMed. Search undertaken on 01/10/2025.

Study selection

Data extraction

Data analysis and results

Data availability

Acknowledgements

References

Comments on this article Comments (0)

Open Peer Review

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Open Peer Review

Reviewer Status

Reviewer Reports

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