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What’s Important?

  1. Acne is the most common condition of the skin worldwide and a common complaint among aesthetic patients of a broad age range due to its highly visible nature on the skin.

  2. The etiology of acne is complex and multifactorial, involving an interplay between Cutibacterium acnes (formerly known as Propionibacterium acnes), inflammation, sebaceous gland hypersecretion, and changes in follicular keratinization.

  3. Though there is not one panacea for acne treatment, staple medications include oral and topical retinoids, comedolytics like salicylic acid, topical and oral antibiotics, and benzoyl peroxide.

What’s New?

  1. There has been increasing evidence of widespread antibiotic resistance among C. acnes, though combination therapy with benzoyl peroxide is an effective way to prevent resistance. The newest FDA-approved narrow-spectrum tetracycline, sarecycline, has promising efficacy with fewer systemic side effects and less potential for inducing resistance.

  2. The oral anti-androgen agent spironolactone continues to be incorporated into regimens for female patients. However, the novel topical anti-androgen clascoterone has been shown to have minimal systemic absorption and is thus safe for all patients.

  3. A recent uptrend of acne mechanica and acne cosmetica is likely to continue with increased mask-wearing due to airborne pathogens like SARS-CoV-2 and the rapid trend cycle of skincare products in a burgeoning marketplace that has many start-up companies with less established research and development.

What’s Coming?

  1. Future treatment routines may include light and laser therapy, which use photosensitive adjuncts to target C. acnes or the sebaceous gland and reduce inflammation and sebum production with minimal systemic effects. Gold microparticle-mediated photothermal therapy is a newly FDA-cleared modality to decrease sebum production that uses gold microspheres as the adjunct.

  2. There is increasing interest and understanding of the role of diet in acne and how lifestyle modification, including plant-based diets, could play a role in treating and preventing acne.

Any discussion of the practice of cosmetic dermatology must include a discussion of acne. Although acne is not typically considered to be a “cosmetic” problem, its highly visible nature makes it a very common complaint among aesthetic patients who are by definition concerned about their appearance. Acne often has a profound psychosocial impact on patients. Patients with acne may experience tremendous impairment in self-image and a decrease in quality of life equivalent to disorders such as asthma, epilepsy, and diabetes.1,2 Acne can be especially troublesome to adults who perceive themselves as too old to have this condition most often associated with adolescence.

Acne vulgaris is a common, multifactorial process involving the pilosebaceous unit. More than 50 million people3 and 75 to 95% of all teens4 are affected by some form of acne each year in the United States alone. Acne is estimated to affect 9.4% of the global population, making it the eighth most prevalent disease worldwide.5 The majority of patients outside this age range are adult women who typically exhibit a hormonal component to their acne. Approximately 12 to 22% ...

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