Acne Vulgaris

Key Points

  • Acne is a common condition affecting persons of almost all ages; it may begin as early as the neonatal period, and peaks between ages of 13-17. For some patients, acne will persist into the fourth or fifth decade of life.
  • Acne is a chronic disease that requires initial and long-term (i.e., maintenance) therapy.
  • Even though it is not a life-threatening disease, acne can have significant impact on a patient’s quality of life, including physical and psychological scars.
  • Distribution, number, and severity of lesions (especially scarring) should influence the approach to acne treatment.
  • Expert consensus suggests that a topical retinoid is first-line initial and maintenance therapy for almost all acne patients (except the most severe forms).
  • Antibiotic resistance caused by antibiotic monotherapy is an emerging clinical problem in acne management; antibiotic resistance leads to acne treatment failure. Therefore, the use of topical or systemic antibiotic monotherapy, especially long-term use, is not recommended in either the initial or maintenance phase of treatment.
  • There are multiple strategies that can be employed to limit emergence of antibiotic resistance: combination of a topical retinoid and benzoyl peroxide, antibiotic and benzoyl peroxide, topical retinoid and antibiotic, and use of either topical retinoid or benzoyl peroxide alone. However, use of combination therapy in many cases is more effective for the treatment of acne and several combination formulations are available. The convenience of combination formulations may also improve patient adherence to their acne skin regimen.
  • A combination formulation containing a topical retinoid and the antimicrobial agent benzoyl peroxide (such as EpiDuo) may accomplish the treatment goal of providing a first-line topical retinoid and a strategy to prevent antibiotic resistance consistent with the best practice of avoiding long-term topical antibiotic use.

Acne vulgaris is characterized by comedones, papules, and pustules, or a combination of lesions. Nodules, cysts, and scarring are seen in more severe disease. Factors involved in the pathogenesis of acne include: alteration of follicular keratinization, presence of bacteria (Propionibacterium acnes), sex hormone production (androgens) and sebum production.