What are the different therapies to treat Acne Vulgaris?

Acne is a chronic skin condition characterized by open or closed comedones and inflammatory lesions such as papules, pustules, and nodules. It progresses through four stages: increased sebum production by sebaceous glands, follicular colonization, release of inflammatory mediators, and increased follicular keratinization. Circulating androgens cause sebaceous glands to enlarge and become more active, leading to increased keratinization of epidermal cells and the development of obstructed sebaceous follicles. Cells stick together, forming a dense keratinous plug. Excess sebum gets trapped behind this plug and solidifies, resulting in the formation of open or closed comedones. Noninflammatory acne lesions include closed and open comedones, commonly known as whiteheads and blackheads. Closed comedones, the first visible acne lesion, are almost completely obstructed and prone to rupture. Open comedones form when the plug extends to the upper canal and dilates its opening. Inflammatory acne lesions consist of papules, pustules, and nodules. Pus formation occurs due to the recruitment of neutrophils into the follicle during the inflammatory process and the release of Propionibacterium acnes-generated chemokines.

The primary goals in treating acne vulgaris are to reduce the number and severity of lesions, improve appearance, slow disease progression, limit duration and recurrence, prevent scarring and hyperpigmentation, and alleviate psychological distress. The most critical treatment target is the microcomedone, as eliminating follicular occlusion can halt the acne cascade. Treatment strategies include both nonpharmacologic and pharmacologic measures aimed at cleansing, reducing triggers, and combining therapies to address all four pathogenic mechanisms of acne. Combination therapy is often more effective than monotherapy and may reduce side effects and minimize resistance or tolerance to individual treatments. The treatment approach depends on factors such as the severity of acne, types of lesions, treatment preferences, cost, skin type, age, adherence, response to previous therapies, presence of scarring, psychological effects, and family history of persistent acne. Topical therapy is typically the standard of care for mild to moderate acne, while systemic therapy is used for moderate to severe cases.

Various therapies exist for treating acne, encompassing both nonpharmacologic and pharmacologic options. Nonpharmacologic therapies include physical treatments such as comedone extraction, cryotherapy, intralesional corticosteroids, and optical treatments like UV light. Pharmacologic therapies are divided into topical and systemic treatments. Topical treatments include retinoids (adapalene, isotretinoin, tazarotene, tretinoin), antibiotics (clindamycin, erythromycin), and other agents like azelaic acid, benzoyl peroxide, chemical peels, corticosteroids, dapsone, hydrogen peroxide, niacinamide, salicylic acid, sodium sulfacetamide, and triclosan. Systemic treatments include retinoids (isotretinoin) and a broader range of antibiotics (azithromycin, clindamycin, doxycycline, erythromycin, levofloxacin, minocycline). Hormonal contraceptives are also used in certain cases, along with other treatments like corticosteroids, ibuprofen, and zinc sulfate. Treatment regimens can involve monotherapy or combination therapy, tailored to factors such as acne severity, lesion type, and patient preference.

Kraft, J., & Freiman, A. (2011). Management of acne. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 183(7), E430–E435. https://doi.org/10.1503/cmaj.090374

Ayer, J., & Burrows, N. (2006). Acne: more than skin deep. Postgraduate medical journal, 82(970), 500–506. https://doi.org/10.1136/pgmj.2006.045377