Acne Vulgaris Management: A Review of First-Line and Advanced Pharmacological Treatments
DOI:
https://doi.org/10.12775/JEHS.2025.78.57570Keywords
acne vulgaris, topical retinoid therapy, systemic antibiotics, topical antibiotics, isotretinoinAbstract
Introduction and objective: Acne vulgaris is a common chronic inflammatory skin disease affecting hair and sebaceous follicles, characterized by skin lesions most commonly appearing on the face. Several factors predispose individuals to the development of acne, including hormonal imbalances, genetic predisposition, and the use of certain medications. This review aims to evaluate and summarize first-line and advanced pharmacological treatments for acne vulgaris, highlighting their efficacy, safety, and emerging therapies for optimal management.
Review methods: The literature review utilized databases covering sources from PubMed, Google Scholar, Scopus, and Web of Science using the search terms encompassing the following keywords: ‘acne vulgaris’ and ‘topical retinoid therapy’, ‘benzoyl peroxide’, ‘azelaic acid’, ‘topical antibiotics’, ‘oral antibiotics’, ‘contraceptive agents’, ‘antiandrogen therapy’, ‘isotretinoin’.
Brief description of the state of knowledge: Current treatment methods range from topical therapies (i.e. antibiotics and retinoids) for mild cases to systemic medications (i.e. antibiotics, retinoids, and hormonal) for moderate to severe acne. In most cases, treatment should start with topical therapy.
Summary: Early intervention is crucial to mitigate the risk of scarring and psychosocial consequences. Emerging therapeutic strategies have the potential to enhance treatment outcomes.
References
1. González-Mondragón EA, Ganoza-Granados LDC, Toledo-Bahena ME, et al. Acne and diet: a review of pathogenic mechanisms. Bol Med Hosp Infant Mex. 2022;79(2):83-90. doi:10.24875/BMHIM.21000088.
2. Bae IH, Kwak JH, Na CH, Kim MS, Shin BS, Choi H. A Comprehensive Review of the Acne Grading Scale in 2023. Annals of Dermatology. 2024;36(2):65-73. doi:10.5021/ad.23.094.
3. Dréno B, Thiboutot D, Layton AM, et al. Large-scale international study enhances understanding of an emerging acne population: adult females. J Eur Acad Dermatol Venereol. 2015;29(6):1096-1106. doi:10.1111/jdv.12757.
4. Alyoussef A. The Impact of Consuming Probiotics and Following a Vegetarian Diet on the Outcomes of Acne. Cureus. 2024;16(1):e51563. doi:10.7759/cureus.51563.
5. Baldwin H, Tan J. Effects of Diet on Acne and Its Response to Treatment. Am J Clin Dermatol. 2021;22(1):55-65. doi:10.1007/s40257-020-00542-y.
6. Ryguła I, Pikiewicz W, Kaminiów K. Impact of Diet and Nutrition in Patients with Acne Vulgaris. Nutrients. 2024;16(10):1476. doi:10.3390/nu16101476.
7. de Vries FMC, Meulendijks AM, Driessen RJB, van Dooren AA, Tjin EPM, van de Kerkhof PCM. The efficacy and safety of non-pharmacological therapies for the treatment of acne vulgaris: A systematic review and best-evidence synthesis. J Eur Acad Dermatol Venereol. 2018;32(7):1195-1203. doi:10.1111/jdv.14881.
8. Fox L, Csongradi C, Aucamp M, Plessis J du, Gerber M. Treatment Modalities for Acne. Molecules. 2016;21(8):1063. doi:10.3390/molecules21081063.
9. Dessinioti C, Katsambas AD. The role of Propionibacterium acnes in acne pathogenesis: facts and controversies. Clin Dermatol. 2010;28(1):2-7. doi:10.1016/j.clindermatol.2009.03.012.
10. Reynolds RV, Yeung H, Cheng CE, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2024;90(5):1006.e1-1006.e30. doi:10.1016/j.jaad.2023.12.017.
11. Kolli SS, Pecone D, Pona A, Cline A, Feldman SR. Topical Retinoids in Acne Vulgaris: A Systematic Review. Am J Clin Dermatol. 2019;20(3):345-365. doi:10.1007/s40257-019-00423-z.
12. Nast A, Dréno B, Bettoli V, et al. European evidence-based (S3) guideline for the treatment of acne - update 2016 - short version. J Eur Acad Dermatol Venereol. 2016;30(8):1261-1268. doi:10.1111/jdv.13776.
13. Tanghetti EA, Zeichner JA, Gold M, et al. Improvements in acne and skin oiliness with tazarotene 0.045% lotion in patients with oily skin. J Dermatolog Treat. 2023;34(1):2147391. doi:10.1080/09546634.2022.2147391.
14. Leyden J, Kaidbey K, Levy SF. The combination formulation of clindamycin 1% plus benzoyl peroxide 5% versus 3 different formulations of topical clindamycin alone in the reduction of Propionibacterium acnes. An in vivo comparative study. Am J Clin Dermatol. 2001;2(4):263-266. doi:10.2165/00128071-200102040-00007.
15. Alvarez-Sánchez M, Rodríguez-Ayala E, Ponce-Olivera RM, Tirado-Sánchez A, Arellano-Mendoza MI. [Bacterial resistance in acne? A meta-analysis of the controversy]. Cir Cir. 2016;84(3):190-195. doi:10.1016/j.circir.2015.08.005.
16. Jacobs A, Starke G, Rosumeck S, Nast A. Systematic review on the rapidity of the onset of action of topical treatments in the therapy of mild-to-moderate acne vulgaris. Br J Dermatol. 2014;170(3):557-564. doi:10.1111/bjd.12706.
17. Drugs for acne. Med Lett Drugs Ther. 2020;62(1612):188-191. www.secure.medicalletter.org/TML-article-1612c (access 2024.12.20).
18. Gollnick HPM, Graupe K, Zaumseil RP. [Azelaic acid 15% gel in the treatment of acne vulgaris. Combined results of two double-blind clinical comparative studies]. J Dtsch Dermatol Ges. 2004;2(10):841-847. doi:10.1046/j.1439-0353.2004.04731.x.
19. Liu H, Yu H, Xia J, et al. Topical azelaic acid, salicylic acid, nicotinamide, sulphur, zinc and fruit acid (alpha-hydroxy acid) for acne. Cochrane Database Syst Rev. 2020;5(5):CD011368. doi:10.1002/14651858.CD011368.pub2.
20. Eichenfield DZ, Sprague J, Eichenfield LF. Management of Acne Vulgaris: A Review. JAMA. 2021;326(20):2055-2067. doi:10.1001/jama.2021.17633.
21. Hebert A, Thiboutot D, Stein Gold L, et al. Efficacy and Safety of Topical Clascoterone Cream, 1%, for Treatment in Patients With Facial Acne: Two Phase 3 Randomized Clinical Trials. JAMA Dermatol. 2020;156(6):621-630. doi:10.1001/jamadermatol.2020.0465.
22. Bosanac SS, Trivedi M, Clark AK, Sivamani RK, Larsen LN. Progestins and acne vulgaris: a review. Dermatol Online J. 2018;24(5):13030/qt6wm945xf.
23. Harper JC. Use of Oral Contraceptives for Management of Acne Vulgaris: Practical Considerations in Real World Practice. Dermatol Clin. 2016;34(2):159-165. doi:10.1016/j.det.2015.11.005.
24. Eichenfield LF, Krakowski AC, Piggott C, et al. Evidence-based recommendations for the diagnosis and treatment of pediatric acne. Pediatrics. 2013;131 Suppl 3:S163-186. doi:10.1542/peds.2013-0490B.
25. Katsambas AD, Dessinioti C. Hormonal therapy for acne: why not as first line therapy? facts and controversies. Clin Dermatol. 2010;28(1):17-23. doi:10.1016/j.clindermatol.2009.03.006.
26. Patiyasikunt M, Chancheewa B, Asawanonda P, Noppakun N, Kumtornrut C. Efficacy and tolerability of low-dose spironolactone and topical benzoyl peroxide in adult female acne: A randomized, double-blind, placebo-controlled trial. J Dermatol. 2020;47(12):1411-1416. doi:10.1111/1346-8138.15559.
27. Grandhi R, Alikhan A. Spironolactone for the Treatment of Acne: A 4-Year Retrospective Study. Dermatology. 2017;233(2-3):141-144. doi:10.1159/000471799.
28. Vasam M, Korutla S, Bohara RA. Acne vulgaris: A review of the pathophysiology, treatment, and recent nanotechnology based advances. Biochem Biophys Rep. 2023;36:101578. doi:10.1016/j.bbrep.2023.101578.
29. Baldwin H. Oral Antibiotic Treatment Options for Acne Vulgaris. J Clin Aesthet Dermatol. 2020;13(9):26-32.
30. Xu H, Li H. Acne, the Skin Microbiome, and Antibiotic Treatment. Am J Clin Dermatol. 2019;20(3):335-344. doi:10.1007/s40257-018-00417-3.
31. Shields A, Barbieri JS. From Breakouts to Bargains: Strategies for Patient-Centered, Cost-effective Acne Care. Cutis. 2023;112(2):E24-E29. doi:10.12788/cutis.0844.
32. Swallow MA, Fan R, Cohen JM, Bunick CG. Antibiotic Resistance Risk with Oral Tetracycline Treatment of Acne Vulgaris. Antibiotics (Basel). 2022;11(8):1032. doi:10.3390/antibiotics11081032.
33. Tolino E, Skroza N, Mambrin A, et al. An Open-label Study Comparing Oral Zinc to Lymecycline in the Treatment of Acne Vulgaris. J Clin Aesthet Dermatol. 2021;14(5):56-58.
34. Bossuyt L, Bosschaert J, Richert B, et al. Lymecycline in the treatment of acne: an efficacious, safe and cost-effective alternative to minocycline. Eur J Dermatol. 2003;13(2):130-135.
35. Armillei MK, Lomakin IB, Del Rosso JQ, Grada A, Bunick CG. Scientific Rationale and Clinical Basis for Clindamycin Use in the Treatment of Dermatologic Disease. Antibiotics (Basel). 2024;13(3):270. doi:10.3390/antibiotics13030270.
36. Walsh TR, Efthimiou J, Dréno B. Systematic review of antibiotic resistance in acne: an increasing topical and oral threat. Lancet Infect Dis. 2016;16(3):e23-33. doi:10.1016/S1473-3099(15)00527-7.
37. Santer M, Burden-Teh E, Ravenscroft J. Managing acne vulgaris: an update. Drug Ther Bull. 2023;62(1):6-10. doi:10.1136/dtb.2023.000051.
38. Han JJ, Faletsky A, Barbieri JS, Mostaghimi A. New Acne Therapies and Updates on Use of Spironolactone and Isotretinoin: A Narrative Review. Dermatol Ther (Heidelb). 2021;11(1):79-91. doi:10.1007/s13555-020-00481-w.
39. Barbieri JS, Roe AH, Mostaghimi A. Simplifying contraception requirements for iPLEDGE: A decision analysis. J Am Acad Dermatol. 2020;83(1):104-108. doi:10.1016/j.jaad.2020.02.022.
40. Singer S, Tkachenko E, Sharma P, Barbieri JS, Mostaghimi A. Psychiatric Adverse Events in Patients Taking Isotretinoin as Reported in a Food and Drug Administration Database From 1997 to 2017. JAMA Dermatol. 2019;155(10):1162-1166. doi:10.1001/jamadermatol.2019.1416.
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