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Truncal Acne and Scarring: A Comprehensive Review of Current Medical and Cosmetic Approaches to Treatment and Patient Management

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Abstract

Acne vulgaris is one of the most common skin disorders worldwide. It typically affects skin areas with a high density of sebaceous glands such as the face, upper arms, chest, and/or back. Historically, the majority of research efforts have focused on facial acne vulgaris, even though approximately half of patients with facial lesions demonstrate truncal involvement. Truncal acne vulgaris is challenging to treat and poses a significant psychosocial burden on patients. Despite these characteristics, studies specifically examining truncal acne vulgaris are limited, with treatment guidelines largely derived from facial protocols. Therefore, truncal acne remains an understudied clinical problem. Here, we provide a clinically focused review on the epidemiology, evaluation, and available treatment options for truncal acne vulgaris. In doing so, we highlight knowledge gaps with the goal of spurring further investigation into the management of truncal acne vulgaris.

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References

  1. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2163–96.

    Article  PubMed  PubMed Central  Google Scholar 

  2. McConnell RC, Fleischer AB Jr, Williford PM, et al. Most topical tretinoin treatment is for acne vulgaris through the age of 44 years: an analysis of the National Ambulatory Medical Care Survey, 1990–1994. J Am Acad Dermatol. 1998;38:221–6.

    Article  CAS  PubMed  Google Scholar 

  3. Collier CN, Harper JC, Cafardi JA, et al. The prevalence of acne in adults 20 years and older. J Am Acad Dermatol. 2008;58:56–9.

    Article  PubMed  Google Scholar 

  4. Moradi Tuchayi S, Makrantonaki E, Ganceviciene R, et al. Acne vulgaris. Nat Rev Dis Primers. 2015;1:15029.

    Article  PubMed  Google Scholar 

  5. Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74:945–73.

    Article  PubMed  Google Scholar 

  6. Nast A, Dreno 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;30:1261–8.

    Article  CAS  PubMed  Google Scholar 

  7. Del Rosso JQ, Bikowski JB, Baum E, et al. A closer look at truncal acne vulgaris: prevalence, severity, and clinical significance. J Drugs Dermatol. 2007;6:597–600.

    PubMed  Google Scholar 

  8. Del Rosso JQ, Stein-Gold L, Lynde C, et al. Truncal acne: a neglected entity. J Drugs Dermatol. 2019;18:205–1208.

    PubMed  Google Scholar 

  9. Tan J, Beissert S, Cook-Bolden F, et al. Impact of facial and truncal acne on quality of life: a multi-country population-based survey. JAAD Int. 2021;3:102–10.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Papadopoulos L, Walker C, Aitken D, Bor R. The relationship between body location and psychological morbidity in individuals with acne vulgaris. Psychol Health Med. 2000;5:431–8.

    Article  Google Scholar 

  11. Hassan J, Grogan S, Clark-Carter D, et al. The individual health burden of acne: appearance-related distress in male and female adolescents and adults with back, chest and facial acne. J Health Psychol. 2009;14:1105–18.

    Article  PubMed  Google Scholar 

  12. Tan JJK, Tang J, Fung K, et al. Prevalence and severity of facial and truncal acne in a referral cohort. J Drugs Dermatol. 2008;7:551–6.

    PubMed  Google Scholar 

  13. Dreno B, Jean-Decoster C, Georgescu V. Profile of patients with mild-to-moderate acne in Europe: a survey. Eur J Dermatol. 2016;26:177–84.

    Article  CAS  PubMed  Google Scholar 

  14. Goncalves G, Amado JM, Matos ME, et al. The prevalence of acne among a group of Portuguese medical students. J Eur Acad Dermatol Venereol. 2012;6:514–7.

    Article  Google Scholar 

  15. Tan J, Del Rosso JQ, Weiss JS, et al. Prevalence and demographics of truncal involvement among acne patients: survey data and a review of the literature. J Clin Aesthet Dermatol. 2022;15:62–7.

    PubMed  PubMed Central  Google Scholar 

  16. Isaacsson VC, Almeida JRHL, Duquia RP, et al. Dissatisfaction and acne vulgaris in male adolescents and associated factors. An Bras Dermatol. 2014;89:576–9.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Dreno 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;29:1096–106.

    Article  CAS  PubMed  Google Scholar 

  18. Radi R, Gold S, Acosta JP, et al. Treating acne in transgender persons receiving testosterone: a practical guide. Am J Clin Dermatol. 2022;23:219–29.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Wierckx K, Van de Peer F, Verhaeghe E, et al. Short- and long-term clinical skin effects of testosterone treatment in trans men. J Sex Med. 2014;11:222–9.

    Article  CAS  PubMed  Google Scholar 

  20. Plewig G, Melnik B, Chen W. Acne-mimicking diseases, Plewig and Kligman’s acne and rosacea. Cham: Springer International Publishing; 2019. p. 299–410.

    Google Scholar 

  21. Wu DC, Chan WW, Metelitsa AI, et al. Pseudomonas skin infection: clinical features, epidemiology, and management. Am J Clin Dermatol. 2011;12:157–69.

    Article  PubMed  Google Scholar 

  22. Boni R, Nehrhoff B. Treatment of gram-negative folliculitis in patients with acne. Am J Clin Dermatol. 2003;4:273–6.

    Article  PubMed  Google Scholar 

  23. Luelmo-Aguilar J, Santandreu MS. Folliculitis: recognition and management. Am J Clin Dermatol. 2004;5:301–10.

    Article  PubMed  Google Scholar 

  24. Back O, Faergemann J, Hornqvist R. Pityrosporum folliculitis: a common disease of the young and middle-aged. J Am Acad Dermatol. 1985;12:56–61.

    Article  CAS  PubMed  Google Scholar 

  25. Ayers K, Sweeney SM, Wiss K. Pityrosporum folliculitis: diagnosis and management in 6 female adolescents with acne vulgaris. Arch Pediatr Adolesc Med. 2005;159:64–7.

    Article  PubMed  Google Scholar 

  26. Ponka D, Baddar F. Wood lamp examination. Can Fam Physician. 2012;58:976.

    PubMed  PubMed Central  Google Scholar 

  27. Durdu M, Guran M, Ilkit M. Epidemiological characteristics of Malassezia folliculitis and use of the May-Grunwald-Giemsa stain to diagnose the infection. Diagn Microbiol Infect Dis. 2013;76:450–7.

    Article  PubMed  Google Scholar 

  28. Poli F. Differential diagnosis of facial acne on black skin. Int J Dermatol. 2012;51(24–26):27–9.

    Article  Google Scholar 

  29. Jacinto-Jamora S, Tamesis J, Katigbak ML. Pityrosporum folliculitis in the Philippines: diagnosis, prevalence, and management. J Am Acad Dermatol. 1991;24:693–6.

    Article  CAS  PubMed  Google Scholar 

  30. Hald M, Arendrup MC, Svejgaard EL, et al. Evidence-based Danish guidelines for the treatment of Malassezia-related skin diseases. Acta Derm Venereol. 2015;95:12–9.

    Article  CAS  PubMed  Google Scholar 

  31. Rosenthal D, LeBoit PE, Klumpp L, et al. Human immunodeficiency virus-associated eosinophilic folliculitis: a unique dermatosis associated with advanced human immunodeficiency virus infection. Arch Dermatol. 1991;127:206–9.

    Article  CAS  PubMed  Google Scholar 

  32. Parker SR, Parker DC, McCall CO. Eosinophilic folliculitis in HIV-infected women: case series and review. Am J Clin Dermatol. 2006;7:193–200.

    Article  PubMed  Google Scholar 

  33. Bull RH, Harland CA, Fallowfield ME, et al. Eosinophilic folliculitis: a self-limiting illness in patients being treated for haematological malignancy. Br J Dermatol. 1993;129:178–82.

    Article  CAS  PubMed  Google Scholar 

  34. Evans TR, Mansi JL, Bull R, et al. Eosinophilic folliculitis occurring after bone marrow autograft in a patient with non-Hodgkin’s lymphoma. Cancer. 1994;73:2512–4.

    Article  CAS  PubMed  Google Scholar 

  35. Teraki Y, Konohana I, Shiohara T, et al. Eosinophilic pustular folliculitis (Ofuji’s disease): immunohistochemical analysis. Arch Dermatol. 1993;129:1015–9.

    Article  CAS  PubMed  Google Scholar 

  36. Ellis E, Scheinfeld N. Eosinophilic pustular folliculitis: a comprehensive review of treatment options. Am J Clin Dermatol. 2004;5:189–97.

    Article  PubMed  Google Scholar 

  37. Paichitrojjana A. Demodicosis imitating acne vulgaris: a case report. Clin Cosmet Investig Dermatol. 2022;15:497–501.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Chen W, Plewig G. Human demodicosis: revisit and a proposed classification. Br J Dermatol. 2014;170:1219–25.

    Article  CAS  PubMed  Google Scholar 

  39. Forton F, Seys B. Density of Demodex folliculorum in rosacea: a case-control study using standardized skin-surface biopsy. Br J Dermatol. 1993;128:650–9.

    Article  CAS  PubMed  Google Scholar 

  40. Huang HP, Hsu CK, Lee JY. A new superficial needle-scraping method for assessing Demodex density in papulopustular rosacea. J Cosmet Dermatol. 2020;19:896–900.

    Article  PubMed  Google Scholar 

  41. Aktas Karabay E, Aksu CA. Demodex folliculorum infestations in common facial dermatoses: acne vulgaris, rosacea, seborrheic dermatitis. An Bras Dermatol. 2020;95:187–93.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Salem DA, El-Shazly A, Nabih N, et al. Evaluation of the efficacy of oral ivermectin in comparison with ivermectin-metronidazole combined therapy in the treatment of ocular and skin lesions of Demodex folliculorum. Int J Infect Dis. 2013;17:e343–7.

    Article  CAS  PubMed  Google Scholar 

  43. Sarac G. A comparison of the efficacy and tolerability of topical agents used in facial Demodex treatment. J Cosmet Dermatol. 2019;18:1784–7.

    Article  PubMed  Google Scholar 

  44. Bikowski JB, Del Rosso JQ. Demodex dermatitis: a retrospective analysis of clinical diagnosis and successful treatment with topical crotamiton. J Clin Aesthet Dermatol. 2009;2:20–5.

    PubMed  PubMed Central  Google Scholar 

  45. Jacot W, Bessis D, Jorda E, et al. Acneiform eruption induced by epidermal growth factor receptor inhibitors in patients with solid tumours. Br J Dermatol. 2004;151:238–41.

    Article  CAS  PubMed  Google Scholar 

  46. Hurwitz RM. Steroid acne. J Am Acad Dermatol. 1989;21:1179–81.

    Article  CAS  PubMed  Google Scholar 

  47. Nielsen JN, Licht RW, Fogh K. Two cases of acneiform eruption associated with lamotrigine. J Clin Psychiatry. 2004;65:1720–2.

    Article  PubMed  Google Scholar 

  48. Yeung CK, Chan HH. Cutaneous adverse effects of lithium: epidemiology and management. Am J Clin Dermatol. 2004;5:3–8.

    Article  PubMed  Google Scholar 

  49. Bieber T, Simpson EL, Silverberg JI, et al. Abrocitinib versus placebo or dupilumab for atopic dermatitis. N Engl J Med. 2021;384:1101–12.

    Article  CAS  PubMed  Google Scholar 

  50. Kazandjieva J, Tsankov N. Drug-induced acne. Clin Dermatol. 2017;35:156–62.

    Article  PubMed  Google Scholar 

  51. Du-Thanh A, Kluger N, Bensalleh H, et al. Drug-induced acneiform eruption. Am J Clin Dermatol. 2011;12:233–45.

    Article  PubMed  Google Scholar 

  52. Scope A, Agero AL, Dusza SW, et al. Randomized double-blind trial of prophylactic oral minocycline and topical tazarotene for cetuximab-associated acne-like eruption. J Clin Oncol. 2007;25:5390–6.

    Article  CAS  PubMed  Google Scholar 

  53. Wenzel FG, Horn TD. Nonneoplastic disorders of the eccrine glands. J Am Acad Dermatol. 1998;38:1–17.

    Article  CAS  PubMed  Google Scholar 

  54. Carter R 3rd, Garcia AM, Souhan BE. Patients presenting with miliaria while wearing flame resistant clothing in high ambient temperatures: a case series. J Med Case Rep. 2011;5:474.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Ale I, Lachapelle JM, Maibach HI. Skin tolerability associated with transdermal drug delivery systems: an overview. Adv The. 2009;26:920–35.

    CAS  Google Scholar 

  56. Hu CH, Michel B, Farber EM. Transient acantholytic dermatosis (Grover’s disease): a skin disorder related to heat and sweating. Arch Dermatol. 1985;121:1439–41.

    Article  CAS  PubMed  Google Scholar 

  57. French LE, Piletta PA, Etienne A, et al. Incidence of transient acantholytic dermatosis (Grover’s disease) in a hospital setting. Dermatology. 1999;198:410–1.

    CAS  PubMed  Google Scholar 

  58. Parsons JM. Transient acantholytic dermatosis (Grover’s disease): a global perspective. J Am Acad Dermatol. 1996;35:653–66.

    Article  CAS  PubMed  Google Scholar 

  59. Quirk CJ, Heenan PJ. Grover’s disease: 34 years on. Australas J Dermatol. 2004;45:83–6.

    Article  PubMed  Google Scholar 

  60. Orlowski TJR, Graham LV. Truncal demodex folliculitis. Skin. 2020;2:365–8.

    Article  Google Scholar 

  61. Hafsi W, Badri T. Acne conglobata. Treasure Island: StatPearls; 2022.

    Google Scholar 

  62. Yiu ZZ, Madan V, Griffiths CE. Acne conglobata and adalimumab: use of tumour necrosis factor-alpha antagonists in treatment-resistant acne conglobata, and review of the literature. Clin Exp Dermatol. 2015;40:383–6.

    Article  CAS  PubMed  Google Scholar 

  63. Dessinioti C, Katsambas A. Difficult and rare forms of acne. Clin Dermatol. 2017;35:138–46.

    Article  PubMed  Google Scholar 

  64. Melnik B, Jansen T, Grabbe S. Abuse of anabolic-androgenic steroids and bodybuilding acne: an underestimated health problem. J Dtsch Dermatol Ges. 2017;5:110–7.

    Article  Google Scholar 

  65. Weimann E, Bohles HJ. Acute acne fulminans et conglobata after the end of high-dose testosterone therapy for hereditary tall stature. Klin Padiatr. 1999;211:410–2.

    Article  CAS  PubMed  Google Scholar 

  66. Chicarilli ZN. Follicular occlusion triad: hidradenitis suppurativa, acne conglobata, and dissecting cellulitis of the scalp. Ann Plast Surg. 1987;18:230–7.

    Article  CAS  PubMed  Google Scholar 

  67. Vasanth V, Chandrashekar BS. Follicular occlusion tetrad. Indian Dermatol Online J. 2014;5:491–3.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Musumeci ML, Fiorentini F, Bianchi L, et al. Follicular occlusion tetrad in a male patient with pachyonychia congenita: clinical and genetic analysis. J Eur Acad Dermatol Venereol. 2019;33(Suppl. 6):36–9.

    Article  PubMed  Google Scholar 

  69. Peck GL, Olsen TG, Butkus D, et al. Isotretinoin versus placebo in the treatment of cystic acne. A randomized double-blind study. J Am Acad Dermatol. 1982;6:735–45.

    Article  CAS  PubMed  Google Scholar 

  70. Gollnick HP, Graupe K, Zaumseil RP. Comparison of combined azelaic acid cream plus oral minocycline with oral isotretinoin in severe acne. Eur J Dermatol. 2011;11:538–44.

    Google Scholar 

  71. Tan MG, Worley B, Kim WB, et al. Drug-induced intracranial hypertension:a systematic review and critical assessment of drug-induced causes. Am J Clin Dermatol. 2020;21:163–72.

    Article  PubMed  Google Scholar 

  72. Sand FL, Thomsen SF. Adalimumab for the treatment of refractory acne conglobata. JAMA Dermatol. 2013;149:1306–7.

    Article  PubMed  Google Scholar 

  73. Shirakawa M, Uramoto K, Harada FA. Treatment of acne conglobata with infliximab. J Am Acad Dermatol. 2006;55:344–6.

    Article  PubMed  Google Scholar 

  74. Greywal T, Zaenglein AL, Baldwin HE, et al. Evidence-based recommendations for the management of acne fulminans and its variants. J Am Acad Dermatol. 2017;77:109–17.

    Article  PubMed  Google Scholar 

  75. Li AW, Antaya RJ. Isotretinoin-induced acne fulminans without systemic symptoms with concurrent exuberant granulation tissue. Pediatr Dermatol. 2018;35:257–8.

    Article  PubMed  Google Scholar 

  76. Tan J, Thiboutot D, Popp G, et al. Randomized phase 3 evaluation of trifarotene 50 mug/g cream treatment of moderate facial and truncal acne. J Am Acad Dermatol. 2019;80:1691–9.

    Article  CAS  PubMed  Google Scholar 

  77. Mallon E, Newton JN, Klassen A, et al. The quality of life in acne: a comparison with general medical conditions using generic questionnaires. Br J Dermatol. 1999;140:672–6.

    Article  CAS  PubMed  Google Scholar 

  78. Tan JK, Zhang X, Jones E, et al. Correlation of photographic images from the Leeds revised acne grading system with a six-category global acne severity scale. J Eur Acad Dermatol Venereol. 2013;27:e414–9.

    Article  CAS  PubMed  Google Scholar 

  79. Obrien SCL, Cunliffe WJ. The Leeds revised acne grading system. J Dermatol Treat. 1998;9:215–20.

    Article  Google Scholar 

  80. Allen BS, Smith JG Jr. Various parameters for grading acne vulgaris. Arch Dermatol. 1982;118:23–5.

    Article  CAS  PubMed  Google Scholar 

  81. Tan JK, Tang J, Fung K, et al. Development and validation of a comprehensive acne severity scale. J Cutan Med Surg. 2007;11:211–6.

    Article  PubMed  Google Scholar 

  82. Dreno B, Khammari A, Orain N, et al. ECCA grading scale: an original validated acne scar grading scale for clinical practice in dermatology. Dermatology. 2007;214:46–51.

    Article  CAS  PubMed  Google Scholar 

  83. Goodman GJ, Baron JA. Postacne scarring: a qualitative global scarring grading system. Dermatol Surg. 2006;32:1458–66.

    CAS  PubMed  Google Scholar 

  84. Tan JK, Tang J, Fung K, et al. Development and validation of a scale for acne scar severity (SCAR-S) of the face and trunk. J Cutan Med Surg. 2010;14:156–60.

    Article  PubMed  Google Scholar 

  85. Gupta MA, Johnson AM, Gupta AK. The development of an Acne Quality of Life scale: reliability, validity, and relation to subjective acne severity in mild to moderate acne vulgaris. Acta Derm Venereol. 1998;78:451–6.

    Article  CAS  PubMed  Google Scholar 

  86. Martin AR, Lookingbill DP, Botek A, et al. Health-related quality of life among patients with facial acne: assessment of a new acne-specific questionnaire. Clin Exp Dermatol. 2001;26:380–5.

    Article  CAS  PubMed  Google Scholar 

  87. Tan JKL, Jones E, Allen E, et al. Evaluation of essential clinical components and features of current acne global grading scales. J Am Acad Dermatol. 2013;69:754–61.

    Article  PubMed  Google Scholar 

  88. Barratt H, Hamilton F, Car J, et al. Outcome measures in acne vulgaris: systematic review. Br J Dermatol. 2009;160:132–6.

    Article  CAS  PubMed  Google Scholar 

  89. Doshi A, Zaheer A, Stiller MJ. A comparison of current acne grading systems and proposal of a novel system. Int J Dermatol. 1997;36:416–8.

    Article  CAS  PubMed  Google Scholar 

  90. Bernardis E, Shou H, Barbieri JS, et al. Development and initial validation of a multidimensional acne global grading system integrating primary lesions and secondary changes. JAMA Dermatol. 2020;156:296–302.

    Article  PubMed  PubMed Central  Google Scholar 

  91. Auffret N, Nguyen JM, Leccia MT, et al. TRASS: a global approach to assess the severity of truncal acne. J Eur Acad Dermatol Venereol. 2022;2:2.

    Google Scholar 

  92. Burke BM, Cunliffe WJ. The assessment of acne vulgaris: the Leeds technique. Br J Dermatol. 1984;111:83–92.

    Article  CAS  PubMed  Google Scholar 

  93. Tan J, Alexis A, Baldwin H, et al. Gaps and recommendations for clinical management of truncal acne from the Personalising Acne: Consensus of Experts Panel. JAAD Int. 2021;5:33–40.

    Article  PubMed  PubMed Central  Google Scholar 

  94. Poli F, Auffret N, Leccia MT, et al. Truncal acne, what do we know? J Eur Acad Dermatol Venereol. 2020;34:2241–6.

    Article  CAS  PubMed  Google Scholar 

  95. Kircik L. Efficacy and safety of tazarotene lotion, 0.045% in the treatment of truncal acne vulgaris. J Drugs Dermatol. 2021;21:713–6.

    Google Scholar 

  96. Hoffman LK, Del Rosso JQ, Kircik LH. The efficacy and safety of azelaic acid 15% foam in the treatment of truncal acne vulgaris. J Drugs Dermatol. 2017;16:534–8.

    CAS  PubMed  Google Scholar 

  97. Del Rosso JQ, Kircik L, Tanghetti E. Management of truncal acne vulgaris with topical dapsone 7.5% gel. J Clin Aesthet Dermatol. 2018;11:45–50.

    PubMed  PubMed Central  Google Scholar 

  98. Leyden JJ, Wortzman M, Baldwin EK. Antibiotic-resistant Propionibacterium acnes suppressed by a benzoyl peroxide cleanser 6%. Cutis. 2008;82:417–21.

    PubMed  Google Scholar 

  99. Leyden JJ, Preston N, Osborn C, et al. In-vivo effectiveness of adapalene 0.1%/benzoyl peroxide 2.5% gel on antibiotic-sensitive and resistant Propionibacterium acnes. J Clin Aesthet Dermatol. 2011;4:22–6.

    PubMed  PubMed Central  Google Scholar 

  100. Gollnick H, Cunliffe W, Berson D, et al. Management of acne: a report from a global alliance to improve outcomes in acne. J Am Acad Dermatol. 2003;49:1–37.

    Article  Google Scholar 

  101. Bikowski J. A review of the safety and efficacy of benzoyl peroxide (5.3%) emollient foam in the management of truncal acne vulgaris. J Clin Aesthet Dermatol. 2010;3:26–9.

    PubMed  PubMed Central  Google Scholar 

  102. Leyden JJ. Efficacy of benzoyl peroxide (5.3%) emollient foam and benzoyl peroxide (8%) wash in reducing Propionibacterium acnes on the back. J Drugs Dermatol. 2010;9:622–5.

    PubMed  Google Scholar 

  103. Leyden JJ, Del Rosso JQ. The effect of benzoyl peroxide 9.8% emollient foam on reduction of Propionibacterium acnes on the back using a short contact therapy approach. J Drugs Dermatol. 2012;11:830–3.

    CAS  PubMed  Google Scholar 

  104. Tanghetti E, Abramovits W, Solomon B, et al. Tazarotene versus tazarotene plus clindamycin/benzoyl peroxide in the treatment of acne vulgaris: a multicenter, double-blind, randomized parallel-group trial. J Drugs Dermatol. 2006;5:256–61.

    PubMed  Google Scholar 

  105. Keating GM. Adapalene 0.1%/benzoyl peroxide 2.5% gel: a review of its use in the treatment of acne vulgaris in patients aged >/= 12 years. Am J Clin Dermatol. 2011;12:407–20.

    Article  PubMed  Google Scholar 

  106. Zouboulis CC, Fischer TC, Wohlrab J, et al. Study of the efficacy, tolerability, and safety of 2 fixed-dose combination gels in the management of acne vulgaris. Cutis. 2009;84:223–9.

    PubMed  Google Scholar 

  107. Yang Z, Zhang Y, Lazic Mosler E, et al. Topical benzoyl peroxide for acne. Cochrane Database Syst Rev. 2020;3:11154.

    Google Scholar 

  108. Toyoda M, Morohashi M. An overview of topical antibiotics for acne treatment. Dermatology. 1998;6:130–4.

    Article  Google Scholar 

  109. Mills O Jr, Thornsberry C, Cardin CW, et al. Bacterial resistance and therapeutic outcome following three months of topical acne therapy with 2% erythromycin gel versus its vehicle. Acta Derm Venereol. 2002;82:260–5.

    Article  CAS  PubMed  Google Scholar 

  110. Webster G, Rich P, Gold MH, et al. Efficacy and tolerability of a fixed combination of clindamycin phosphate (1.2%) and low concentration benzoyl peroxide (2.5%) aqueous gel in moderate or severe acne subpopulations. J Drugs Dermatol. 2009;8:736–43.

    PubMed  Google Scholar 

  111. Thiboutot D, Zaenglein A, Weiss J, et al. An aqueous gel fixed combination of clindamycin phosphate 1.2% and benzoyl peroxide 2.5% for the once-daily treatment of moderate to severe acne vulgaris: assessment of efficacy and safety in 2813 patients. J Am Acad Dermatol. 2008;59:792–800.

    Article  PubMed  Google Scholar 

  112. Lookingbill DP, Chalker DK, Lindholm JS, et al. Treatment of acne with a combination clindamycin/benzoyl peroxide gel compared with clindamycin gel, benzoyl peroxide gel and vehicle gel: combined results of two double-blind investigations. J Am Acad Dermatol. 1997;37:590–5.

    Article  CAS  PubMed  Google Scholar 

  113. Tschen EH, Katz HI, Jones TM, et al. A combination benzoyl peroxide and clindamycin topical gel compared with benzoyl peroxide, clindamycin phosphate, and vehicle in the treatment of acne vulgaris. Cutis. 2001;67:165–9.

    CAS  PubMed  Google Scholar 

  114. Leyden JJ, Hickman JG, Jarratt MT, et al. The efficacy and safety of a combination benzoyl peroxide/clindamycin topical gel compared with benzoyl peroxide alone and a benzoyl peroxide/erythromycin combination product. J Cutan Med Surg. 2001;5:37–42.

    Article  CAS  PubMed  Google Scholar 

  115. Pariser DM, Rich P, Cook-Bolden FE, et al. An aqueous gel fixed combination of clindamycin phosphate 1.2% and benzoyl peroxide 3.75% for the once-daily treatment of moderate to severe acne vulgaris. J Drugs Dermatol. 2014;13:1083–9.

    CAS  PubMed  Google Scholar 

  116. F.P. Ltd. Foamix receives FDA approval of Amzeeq™ topical minocycline treatment for millions of moderate to severe acne sufferers, PR Newswire, 2019.

  117. Martins AM, Marto JM, Johnson JL, et al. A review of systemic minocycline side effects and topical minocycline as a safer alternative for treating acne and rosacea. Antibiotics (Basel). 2021;10:2.

    Google Scholar 

  118. Gold LS, Dhawan S, Weiss J, et al. A novel topical minocycline foam for the treatment of moderate-to-severe acne vulgaris: Results of 2 randomized, double-blind, phase 3 studies. J Am Acad Dermatol. 2019;80:168–77.

    Article  CAS  PubMed  Google Scholar 

  119. Kolli SS, Pecone D, Pona A, et al. Topical retinoids in acne vulgaris: a systematic review. Am J Clin Dermatol. 2019;20:345–65.

    Article  PubMed  Google Scholar 

  120. Leyden J, Stein-Gold L, Weiss J. Why topical retinoids are mainstay of therapy for acne. Dermatol Ther (Heidelb). 2017;7:293–304.

    Article  PubMed  PubMed Central  Google Scholar 

  121. Blume-Peytavi U, Fowler J, Kemeny L, et al. Long-term safety and efficacy of trifarotene 50 mug/g cream, a first-in-class RAR-gamma selective topical retinoid, in patients with moderate facial and truncal acne. J Eur Acad Dermatol Venereol. 2020;34:166–73.

    Article  CAS  PubMed  Google Scholar 

  122. Richter JR, Forstrom LR, Kiistala UO, et al. Efficacy of the fixed 1.2% clindamycin phosphate, 0.025% tretinoin gel formulation (Velac) and a proprietary 0.025% tretinoin gel formulation (Aberela) in the topical control of facial acne. J Eur Acad Dermatol Venereol. 1998;11:227–33.

    Article  CAS  PubMed  Google Scholar 

  123. Zouboulis CC, Derumeaux L, Decroix J, et al. A multicentre, single-blind, randomized comparison of a fixed clindamycin phosphate/tretinoin gel formulation (Velac) applied once daily and a clindamycin lotion formulation (Dalacin T) applied twice daily in the topical treatment of acne vulgaris. Br J Dermatol. 2000;143:498–505.

    Article  CAS  PubMed  Google Scholar 

  124. Dreno B, Bettoli V, Ochsendorf F, et al. Efficacy and safety of clindamycin phosphate 1.2%/tretinoin 0.025% formulation for the treatment of acne vulgaris: pooled analysis of data from three randomised, double-blind, parallel-group, phase III studies. Eur J Dermatol. 2014;24:201–9.

    Article  CAS  PubMed  Google Scholar 

  125. Dhillon S. Clascoterone: first approval. Drugs. 2020;80:1745–50.

    Article  CAS  PubMed  Google Scholar 

  126. 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;156:621–30.

    Article  PubMed  Google Scholar 

  127. Ferraboschi P, Legnani L, Celasco G, et al. A full conformational characterization of antiandrogen cortexolone-17 alpha-propionate and related compounds through theoretical calculations and nuclear magnetic resonance spectroscopy. Medchemcomm. 2014;5:904–14.

    Article  CAS  Google Scholar 

  128. Mazzetti A, Moro L, Gerloni M, et al. Pharmacokinetic profile, safety, and tolerability of clascoterone (cortexolone 17-alpha propionate, CB-03-01) topical cream, 1% in subjects with acne vulgaris: an open-label phase 2a study. J Drugs Dermatol. 2019;18:563.

    CAS  PubMed  Google Scholar 

  129. Marks DH, Mansh MD. Potential role for topical antiandrogens in the management of acne among patients receiving masculinizing hormone therapy. JAMA Dermatol. 2020;156:1380–1.

    Article  PubMed  Google Scholar 

  130. Eichenfield L, Hebert A, Gold LS, et al. Open-label, long-term extension study to evaluate the safety of clascoterone (CB-03-01) cream, 1% twice daily, in patients with acne vulgaris. J Am Acad Dermatol. 2020;83:477–85.

    Article  CAS  PubMed  Google Scholar 

  131. Kainz JT, Berghammer G, Auer-Grumbach P, et al. Azelaic acid 20 % cream: effects on quality of life and disease severity in adult female acne patients. J Dtsch Dermatol Ges. 2016;14:1249–59.

    PubMed  Google Scholar 

  132. Eastman WJ, Malahias S, Delconte J, et al. Assessing attributes of topical vehicles for the treatment of acne, atopic dermatitis, and plaque psoriasis. Cutis. 2014;94:46–53.

    PubMed  Google Scholar 

  133. Tan HH. Antibacterial therapy for acne: a guide to selection and use of systemic agents. Am J Clin Dermatol. 2003;4:307–14.

    Article  PubMed  Google Scholar 

  134. Webster GF, McGinley KJ, Leyden JJ. Inhibition of lipase production in Propionibacterium acnes by sub-minimal-inhibitory concentrations of tetracycline and erythromycin. Br J Dermatol. 1981;104:453–7.

    Article  CAS  PubMed  Google Scholar 

  135. Armstrong AW, Hekmatjah J, Kircik LH. Oral tetracyclines and acne: a systematic review for dermatologists. J Drugs Dermatol. 2020;19:s6-13.

    PubMed  Google Scholar 

  136. Leyden JJ, Bruce S, Lee CS, et al. A randomized, phase 2, dose-ranging study in the treatment of moderate to severe inflammatory facial acne vulgaris with doxycycline calcium. J Drugs Dermatol. 2013;12:658–63.

    CAS  PubMed  Google Scholar 

  137. Patel M, Bowe WP, Heughebaert C, et al. The development of antimicrobial resistance due to the antibiotic treatment of acne vulgaris: a review. J Drugs Dermatol. 2010;9:655–64.

    PubMed  Google Scholar 

  138. Del Rosso JQ, Webster GF, Rosen T, et al. Status report from the Scientific Panel on Antibiotic Use in Dermatology of the American Acne and Rosacea Society: part 1: antibiotic prescribing patterns, sources of antibiotic exposure, antibiotic consumption and emergence of antibiotic resistance, impact of alterations in antibiotic prescribing, and clinical sequelae of antibiotic use. J Clin Aesthet Dermatol. 2016;9:18–24.

    PubMed  PubMed Central  Google Scholar 

  139. Thompson KG, Rainer BM, Antonescu C, et al. Minocycline and its impact on microbial dysbiosis in the skin and gastrointestinal tract of acne patients. Ann Dermatol. 2020;32:21–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  140. Francino MP. Antibiotics and the human gut microbiome: dysbioses and accumulation of resistances. Front Microbiol. 2015;6:1543.

    CAS  PubMed  Google Scholar 

  141. Margolis DJ, Fanelli M, Hoffstad O, et al. Potential association between the oral tetracycline class of antimicrobials used to treat acne and inflammatory bowel disease. Am J Gastroenterol. 2010;105:2610–6.

    Article  CAS  PubMed  Google Scholar 

  142. Farrah G, Tan E. The use of oral antibiotics in treating acne vulgaris: a new approach. Dermatol Ther. 2016;29:377–84.

    Article  PubMed  Google Scholar 

  143. US Food and Drug Administration. Seysara® (sarecycline) tablets for oral use (package insert). Approved prescribing information. Almirall LLC.

  144. Deeks ED. Sarecycline: first global approval. Drugs. 2019;79:325–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  145. Batool Z, Lomakin IB, Polikanov YS, et al. Sarecycline interferes with tRNA accommodation and tethers mRNA to the 70S ribosome. Proc Natl Acad Sci U S A. 2020;117:20530–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  146. Bunick CG, Keri J, Tanaka SK, et al. Antibacterial mechanisms and efficacy of sarecycline in animal models of infection and inflammation. Antibiotics (Basel). 2021;10:2.

    Google Scholar 

  147. Zhanel G, Critchley I, Lin LY, et al. Microbiological profile of sarecycline, a novel targeted spectrum tetracycline for the treatment of acne vulgaris. Antimicrob Agents Chemother. 2019;63:2.

    Article  Google Scholar 

  148. Grada A, Bunick CG. Spectrum of antibiotic activity and its relevance to the microbiome. JAMA Netw Open. 2021;4: e215357.

    Article  PubMed  Google Scholar 

  149. Moore A, Green LJ, Bruce S, et al. Once-daily oral sarecycline 1.5 mg/kg/day is effective for moderate to severe acne vulgaris: results from two identically designed, phase 3, randomized, double-blind clinical trials. J Drugs Dermatol. 2018;17:987–96.

    CAS  PubMed  Google Scholar 

  150. Del Rosso JQ, Stein Gold L, Baldwin H, et al. Management of truncal acne with oral sarecycline: pooled results from two phase-3 clinical trials. J Drugs Dermatol. 2021;20:634–40.

    PubMed  Google Scholar 

  151. Nelson AM, Gilliland KL, Cong Z, et al. 13-cis Retinoic acid induces apoptosis and cell cycle arrest in human SEB-1 sebocytes. J Invest Dermatol. 2006;126:2178–89.

    Article  CAS  PubMed  Google Scholar 

  152. Webster GF, Leyden JJ, Gross JA. Results of a phase III, double-blind, randomized, parallel-group, non-inferiority study evaluating the safety and efficacy of Isotretinoin-Lidose in patients with severe recalcitrant nodular acne. J Drugs Dermatol. 2014;13:665–70.

    CAS  PubMed  Google Scholar 

  153. Peck GL, Olsen TG, Yoder FW, et al. Prolonged remissions of cystic and conglobate acne with 13-cis-retinoic acid. N Engl J Med. 1979;300:329–33.

    Article  CAS  PubMed  Google Scholar 

  154. Layton A. The use of isotretinoin in acne. Dermatoendocrinol. 2009;1:162–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  155. Rubinow DR, Peck GL, Squillace KM, et al. Reduced anxiety and depression in cystic acne patients after successful treatment with oral isotretinoin. J Am Acad Dermatol. 1987;17:25–32.

    Article  CAS  PubMed  Google Scholar 

  156. Marron SE, Tomas-Aragones L, Boira S. Anxiety, depression, quality of life and patient satisfaction in acne patients treated with oral isotretinoin. Acta Derm Venereol. 2013;93:701–6.

    Article  PubMed  Google Scholar 

  157. Layton AM, Knaggs H, Taylor J, et al. Isotretinoin for acne vulgaris: 10 years later: a safe and successful treatment. Br J Dermatol. 1993;129:292–6.

    Article  CAS  PubMed  Google Scholar 

  158. Goldsmith LA, Bolognia JL, Callen JP, et al. American Academy of Dermatology Consensus Conference on the safe and optimal use of isotretinoin: summary and recommendations. J Am Acad Dermatol. 2004;50:900–6.

  159. Borghi A, Mantovani L, Minghetti S, et al. Low-cumulative dose isotretinoin treatment in mild-to-moderate acne: efficacy in achieving stable remission. J Eur Acad Dermatol Venereol. 2011;25:1094–8.

    Article  CAS  PubMed  Google Scholar 

  160. Amichai B, Shemer A, Grunwald MH. Low-dose isotretinoin in the treatment of acne vulgaris. J Am Acad Dermatol. 2006;54:644–6.

    Article  PubMed  Google Scholar 

  161. Strauss JS, Rapini RP, Shalita AR, et al. Isotretinoin therapy for acne: results of a multicenter dose-response study. J Am Acad Dermatol. 1984;10:490–6.

    Article  CAS  PubMed  Google Scholar 

  162. Blasiak RC, Stamey CR, Burkhart CN, et al. High-dose isotretinoin treatment and the rate of retrial, relapse, and adverse effects in patients with acne vulgaris. JAMA Dermatol. 2013;49:1392–8.

    Article  Google Scholar 

  163. Cyrulnik AA, Viola KV, Gewirtzman AJ, et al. High-dose isotretinoin in acne vulgaris: improved treatment outcomes and quality of life. Int J Dermatol. 2012;51:1123–30.

    Article  CAS  PubMed  Google Scholar 

  164. Rademaker M. Isotretinoin: dose, duration and relapse. What does 30 years of usage tell us? Australas J Dermatol. 2013;54:157–62.

    Article  PubMed  Google Scholar 

  165. Zouboulis CC. The truth behind this undeniable efficacy: recurrence rates and relapse risk factors of acne treatment with oral isotretinoin. Dermatology. 2006;212:99–100.

    Article  PubMed  Google Scholar 

  166. Quereux G, Volteau C, N’Guyen JM, et al. Prospective study of risk factors of relapse after treatment of acne with oral isotretinoin. Dermatology. 2006;212:168–76.

    Article  CAS  PubMed  Google Scholar 

  167. Cunliffe WJ, Norris JF. Isotretinoin: an explanation for its long-term benefit. Dermatologica. 1987;175(Suppl. 1):133–7.

    Article  PubMed  Google Scholar 

  168. Rademaker M. Adverse effects of isotretinoin: a retrospective review of 1743 patients started on isotretinoin. Australas J Dermatol. 2010;51:248–53.

    Article  PubMed  Google Scholar 

  169. Ellis CN, Krach KJ. Uses and complications of isotretinoin therapy. J Am Acad Dermatol. 2001;45:S150–7.

    Article  CAS  PubMed  Google Scholar 

  170. Marqueling AL, Zane LT. Depression and suicidal behavior in acne patients treated with isotretinoin: a systematic review. Semin Cutan Med Surg. 2007;26:210–20.

    Article  CAS  PubMed  Google Scholar 

  171. Chia CY, Lane W, Chibnall J, et al. Isotretinoin therapy and mood changes in adolescents with moderate to severe acne: a cohort study. Arch Dermatol. 2005;141:557–60.

    Article  CAS  PubMed  Google Scholar 

  172. Rashtak S, Khaleghi S, Pittelkow MR, et al. Isotretinoin exposure and risk of inflammatory bowel disease. JAMA Dermatol. 2014;150:1322–6.

    Article  PubMed  Google Scholar 

  173. Paljarvi T, McPherson T, Luciano S, et al. Isotretinoin and adverse neuropsychiatric outcomes: retrospective cohort study using routine data. Br J Dermatol. 2022;187:64–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  174. Dai WS, LaBraico JM, Stern RS. Epidemiology of isotretinoin exposure during pregnancy. J Am Acad Dermatol. 1992;26:599–606.

    Article  CAS  PubMed  Google Scholar 

  175. Collins MK, Moreau JF, Opel D, et al. Compliance with pregnancy prevention measures during isotretinoin therapy. J Am Acad Dermatol. 2014;70:55–9.

    Article  PubMed  Google Scholar 

  176. Thorneycroft IH, Stanczyk FZ, Bradshaw KD, et al. Effect of low-dose oral contraceptives on androgenic markers and acne. Contraception. 1999;60:255–62.

    Article  CAS  PubMed  Google Scholar 

  177. Panzer C, Wise S, Fantini G, et al. Impact of oral contraceptives on sex hormone-binding globulin and androgen levels: a retrospective study in women with sexual dysfunction. J Sex Med. 2006;3:104–13.

    Article  CAS  PubMed  Google Scholar 

  178. Koo EB, Petersen TD, Kimball AB. Meta-analysis comparing efficacy of antibiotics versus oral contraceptives in acne vulgaris. J Am Acad Dermatol. 2014;71:450–9.

    Article  CAS  PubMed  Google Scholar 

  179. Palli MB, Reyes-Habito CM, Lima XT, et al. A single-center, randomized double-blind, parallel-group study to examine the safety and efficacy of 3mg drospirenone/0.02 mg ethinyl estradiol compared with placebo in the treatment of moderate truncal acne vulgaris. J Drugs Dermatol. 2013;2:633–7.

    Google Scholar 

  180. Lidegaard O, Lokkegaard E, Svendsen AL, et al. Hormonal contraception and risk of venous thromboembolism: national follow-up study. BMJ. 2009;339: b2890.

    Article  PubMed  PubMed Central  Google Scholar 

  181. Jick SS, Hernandez RK. Risk of non-fatal venous thromboembolism in women using oral contraceptives containing drospirenone compared with women using oral contraceptives containing levonorgestrel: case-control study using United States claims data. BMJ. 2011;342: d2151.

    Article  PubMed  PubMed Central  Google Scholar 

  182. Gronich N, Lavi I, Rennert G. Higher risk of venous thrombosis associated with drospirenone-containing oral contraceptives: a population-based cohort study. CMAJ. 2011;183:E1319–25.

    Article  PubMed  PubMed Central  Google Scholar 

  183. Katsambas AD, Dessinioti C. Hormonal therapy for acne: why not as first line therapy? Facts and controversies Clin Dermatol. 2010;28:17–23.

    PubMed  Google Scholar 

  184. van Vlijmen EF, Veeger NJ, Middeldorp S, et al. Thrombotic risk during oral contraceptive use and pregnancy in women with factor V Leiden or prothrombin mutation: a rational approach to contraception. Blood. 2011;118:2055–61; quiz 2375.

  185. Svoboda RM, Nawaz N, Zaenglein AL. Hormonal treatment of acne and hidradenitis suppurativa in adolescent patients. Dermatol Clin. 2022;40:167–78.

    Article  CAS  PubMed  Google Scholar 

  186. Gierisch JM, Coeytaux RR, Urrutia RP, et al. Oral contraceptive use and risk of breast, cervical, colorectal, and endometrial cancers: a systematic review. Cancer Epidemiol Biomarkers Prev. 2013;22:1931–43.

    Article  PubMed  Google Scholar 

  187. Krunic A, Ciurea A, Scheman A. Efficacy and tolerance of acne treatment using both spironolactone and a combined contraceptive containing drospirenone. J Am Acad Dermatol. 2008;58:60–2.

    Article  PubMed  Google Scholar 

  188. Menard RH, Stripp B, Gillette JR. Spironolactone and testicular cytochrome P-450: decreased testosterone formation in several species and changes in hepatic drug metabolism. Endocrinology. 1974;94:1628–36.

    Article  CAS  PubMed  Google Scholar 

  189. Boisselle A, Dionne FT, Tremblay RR. Interaction of spironolactone with rat skin androgen receptor. Can J Biochem. 1979;57:1042–6.

    Article  CAS  PubMed  Google Scholar 

  190. Layton AM, Eady EA, Whitehouse H, et al. Oral spironolactone for acne vulgaris in adult females: a hybrid systematic review. Am J Clin Dermatol. 2017;18:169–91.

    Article  PubMed  PubMed Central  Google Scholar 

  191. Isvy-Joubert A, Nguyen JM, Gaultier A, et al. Adult female acne treated with spironolactone: a retrospective data review of 70 cases. Eur J Dermatol. 2017;27:393–8.

    Article  CAS  PubMed  Google Scholar 

  192. Charny JW, Choi JK, James WD. Spironolactone for the treatment of acne in women, a retrospective study of 110 patients. Int J Womens Dermatol. 2017;3:111–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  193. Shaw JC, White LE. Long-term safety of spironolactone in acne: results of an 8-year followup study. J Cutan Med Surg. 2002;6:541–5.

    Article  PubMed  Google Scholar 

  194. Elsaie ML. Hormonal treatment of acne vulgaris: an update. Clin Cosmet Investig Dermatol. 2016;9:241–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  195. Thiede RM, Rastogi S, Nardone B, et al. Hyperkalemia in women with acne exposed to oral spironolactone: a retrospective study from the RADAR (Research on Adverse Drug Events and Reports) program. Int J Womens Dermatol. 2019;5:155–7.

    Article  PubMed  PubMed Central  Google Scholar 

  196. Plovanich M, Weng QY, Mostaghimi A. Low usefulness of potassium monitoring among healthy young women taking spironolactone for acne. JAMA Dermatol. 2015;151:941–4.

    Article  PubMed  Google Scholar 

  197. Layton AM, Henderson CA, Cunliffe WJ. A clinical evaluation of acne scarring and its incidence. Clin Exp Dermatol. 1994;19:303–8.

    Article  CAS  PubMed  Google Scholar 

  198. Holland DB, Jeremy AH, Roberts SG, et al. Inflammation in acne scarring: a comparison of the responses in lesions from patients prone and not prone to scar. Br J Dermatol. 2004;150:72–81.

    Article  CAS  PubMed  Google Scholar 

  199. Goodman GJ. Postacne scarring: a review of its pathophysiology and treatment. Dermatol Surg. 2000;26:857–71.

    Article  CAS  PubMed  Google Scholar 

  200. Layton A, Alexis A, Baldwin H, et al. Identifying gaps and providing recommendations to address shortcomings in the investigation of acne sequelae by the Personalising Acne: Consensus of Experts panel. JAAD Int. 2021;5:41–8.

    Article  PubMed  PubMed Central  Google Scholar 

  201. Connolly D, Vu HL, Mariwalla K, et al. Acne scarring: pathogenesis, evaluation, and treatment options. J Clin Aesthet Dermatol. 2017;10:12–23.

    PubMed  PubMed Central  Google Scholar 

  202. Jacob CI, Dover JS, Kaminer MS. Acne scarring: a classification system and review of treatment options. J Am Acad Dermatol. 2001;45:109–17.

    Article  CAS  PubMed  Google Scholar 

  203. Jemec GB, Jemec B. Acne: treatment of scars. Clin Dermatol. 2004;22:434–8.

    Article  PubMed  Google Scholar 

  204. Saha AK, Mukhopadhyay M. A comparative clinical study on role of 5-flurouracil versus triamcinolone in the treatment of keloids. Indian J Surg. 2012;74:326–9.

    Article  PubMed  PubMed Central  Google Scholar 

  205. Forbat E, Al-Niaimi F. Nonvascular uses of pulsed dye laser in clinical dermatology. J Cosmet Dermatol. 2019.

  206. Yoon HJ, Lee DH, Kim SO, et al. Acne erythema improvement by long-pulsed 595-nm pulsed-dye laser treatment: a pilot study. J Dermatolog Treat. 2008;19:38–44.

    Article  PubMed  Google Scholar 

  207. Patel N, Clement M. Selective nonablative treatment of acne scarring with 585 nm flashlamp pulsed dye laser. Dermatol Surg. 2002;28:942–5.

    PubMed  Google Scholar 

  208. Lee DH, Choi YS, Min SU, et al. Comparison of a 585-nm pulsed dye laser and a 1064-nm Nd:YAG laser for the treatment of acne scars: a randomized split-face clinical study. J Am Acad Dermatol. 2009;60:801–7.

    Article  PubMed  Google Scholar 

  209. Alster TS. Improvement of erythematous and hypertrophic scars by the 585-nm flashlamp-pumped pulsed dye laser. Ann Plast Surg. 1994;32:186–90.

    Article  CAS  PubMed  Google Scholar 

  210. Khatri KA, Mahoney DL, McCartney MJ. Laser scar revision: a review. J Cosmet Laser Ther. 2011;13:54–62.

    Article  PubMed  Google Scholar 

  211. Vrijman C, van Drooge AM, Limpens J, et al. Laser and intense pulsed light therapy for the treatment of hypertrophic scars: a systematic review. Br J Dermatol. 2011;165:934–42.

    Article  CAS  PubMed  Google Scholar 

  212. Kono T, Ercocen AR, Nakazawa H, et al. The flashlamp-pumped pulsed dye laser (585 nm) treatment of hypertrophic scars in Asians. Ann Plast Surg. 2003;51:366–71.

    Article  PubMed  Google Scholar 

  213. Rao J. Treatment of acne scarring. Facial Plast Surg Clin North Am. 2011;19:275–91.

    Article  PubMed  Google Scholar 

  214. Faghihi G, Isfahani AK, Hosseini SM, et al. Efficacy of intense pulsed light combined with topical erythromycin solution 2% versus topical erythromycin solution 2% alone in the treatment of persistent facial erythematous acne macules. Adv Biomed Res. 2012;1:70.

    PubMed  PubMed Central  Google Scholar 

  215. Feng H, Wu Y, Jiang M, et al. The efficacy and safety of fractional 1064 nm Nd:YAG picosecond laser combined with intense pulsed light in the treatment of atrophic acne scar: a split-face study. Lasers Surg Med. 2021;3:1356–63.

    Article  Google Scholar 

  216. Wang B, Wu Y, Luo YJ, et al. Combination of intense pulsed light and fractional CO(2) laser treatments for patients with acne with inflammatory and scarring lesions. Clin Exp Dermatol. 2013;38:344–51.

    Article  CAS  PubMed  Google Scholar 

  217. Erol OO, Gurlek A, Agaoglu G, et al. Treatment of hypertrophic scars and keloids using intense pulsed light (IPL). Aesthetic Plast Surg. 2008;32:902–9.

    Article  PubMed  Google Scholar 

  218. Piccolo D, Kostaki D, Dianzani C, et al. Effective intense pulsed light protocol in the treatment of moderate to severe acne vulgaris of the chest and back. J Clin Aesthet Dermatol. 2022;15:22–5.

    PubMed  PubMed Central  Google Scholar 

  219. Salameh F, Shumaker PR, Goodman GJ, et al. Energy-based devices for the treatment of acne scars: 2022 international consensus recommendations. Lasers Surg Med. 2022;54:10–26.

    Article  PubMed  Google Scholar 

  220. Cohen BE, Brauer JA, Geronemus RG. Acne scarring: a review of available therapeutic lasers. Lasers Surg Med. 2016;48:95–115.

    Article  PubMed  Google Scholar 

  221. Chapas AM, Brightman L, Sukal S, et al. Successful treatment of acneiform scarring with CO2 ablative fractional resurfacing. Lasers Surg Med. 2008;40:381–6.

    Article  PubMed  Google Scholar 

  222. Chan NP, Ho SG, Yeung CK, et al. Fractional ablative carbon dioxide laser resurfacing for skin rejuvenation and acne scars in Asians. Lasers Surg Med. 2010;42:615–23.

    Article  PubMed  Google Scholar 

  223. Hu S, Hsiao WC, Chen MC, et al. Ablative fractional erbium-doped yttrium aluminum garnet laser with coagulation mode for the treatment of atrophic acne scars in Asian skin. Dermatol Surg. 2011;37:939–44.

    Article  CAS  PubMed  Google Scholar 

  224. Kim S, Cho KH. Clinical trial of dual treatment with an ablative fractional laser and a nonablative laser for the treatment of acne scars in Asian patients. Dermatol Surg. 2009;35:1089–98.

    Article  CAS  PubMed  Google Scholar 

  225. Cameli N, Mariano M, Serio M, et al. Preliminary comparison of fractional laser with fractional laser plus radiofrequency for the treatment of acne scars and photoaging. Dermatol Surg. 2014;40:553–61.

    Article  CAS  PubMed  Google Scholar 

  226. Faghihi G, Keyvan S, Asilian A, et al. Efficacy of autologous platelet-rich plasma combined with fractional ablative carbon dioxide resurfacing laser in treatment of facial atrophic acne scars: a split-face randomized clinical trial. Indian J Dermatol Venereol Leprol. 2016;82:162–8.

    Article  PubMed  Google Scholar 

  227. Gawdat HI, Hegazy RA, Fawzy MM, et al. Autologous platelet rich plasma: topical versus intradermal after fractional ablative carbon dioxide laser treatment of atrophic acne scars. Dermatol Surg. 2014;40:152–61.

    Article  CAS  PubMed  Google Scholar 

  228. Lee JW, Kim BJ, Kim MN, et al. The efficacy of autologous platelet rich plasma combined with ablative carbon dioxide fractional resurfacing for acne scars: a simultaneous split-face trial. Dermatol Surg. 2011;37:931–8.

    Article  CAS  PubMed  Google Scholar 

  229. Preissig J, Hamilton K, Markus R. Current laser resurfacing technologies: a review that delves beneath the surface. Semin Plast Surg. 2012;26:109–16.

    Article  PubMed  PubMed Central  Google Scholar 

  230. Elsaie ML, Ibrahim SM, Saudi W. Ablative fractional 10 600 nm carbon dioxide laser versus non-ablative fractional 1540 nm erbium-glass laser in Egyptian post-acne scar patients. J Lasers Med Sci. 2018;9:32–5.

    Article  PubMed  Google Scholar 

  231. Cheng X, Yang Q, Su Y, et al. Comparison of 1565-nm nonablative fractional laser and 10600-nm ablative fractional laser in the treatment of mild to moderate atrophic acne scars. Dermatol Surg. 2021;47:392–6.

    CAS  PubMed  Google Scholar 

  232. Sardana K, Manjhi M, Garg VK, et al. Which type of atrophic acne scar (ice-pick, boxcar, or rolling) responds to nonablative fractional laser therapy? Dermatol Surg. 2014;40:288–300.

    Article  CAS  PubMed  Google Scholar 

  233. Chan NP, Ho SG, Yeung CK, et al. The use of non-ablative fractional resurfacing in Asian acne scar patients. Lasers Surg Med. 2010;42:710–5.

    PubMed  Google Scholar 

  234. Alexis AF, Coley MK, Nijhawan RI, et al. Nonablative fractional laser resurfacing for acne scarring in patients with Fitzpatrick skin phototypes IV-VI. Dermatol Surg. 2016;42:392–402.

    Article  CAS  PubMed  Google Scholar 

  235. Torbeck RL, Schilling L, Khorasani H, et al. Evolution of the picosecond laser: a review of literature. Dermatol Surg. 2019;45:183–94.

    Article  CAS  PubMed  Google Scholar 

  236. Lee CH, Jin EM, Seo HS, et al. Efficacy and safety of treatment with fractional 1,064-nm picosecond laser with diffractive optic element for wrinkles and acne scars: a clinical study. Ann Dermatol. 2021;33:254–62.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  237. Choi ME, Paik SH, Lee WJ, et al. Treatment of acne scars with a fractional 1064-nm Nd:YAG picosecond laser and histopathologic findings. Dermatol Ther. 2020;33: e13297.

    Article  PubMed  Google Scholar 

  238. Chayavichitsilp P, Limtong P, Triyangkulsri K, et al. Comparison of fractional neodymium-doped yttrium aluminum garnet (Nd:YAG) 1064-nm picosecond laser and fractional 1550-nm erbium fiber laser in facial acne scar treatment. Lasers Med Sci. 2020;35:695–700.

    Article  PubMed  Google Scholar 

  239. Sirithanabadeekul P, Tantrapornpong P, Rattakul B, et al. Comparison of fractional picosecond 1064-nm laser and fractional carbon dioxide laser for treating atrophic acne scars: a randomized split-face trial. Dermatol Surg. 2021;47:e58-65.

    Article  CAS  PubMed  Google Scholar 

  240. Brauer JA, Kazlouskaya V, Alabdulrazzaq H, et al. Use of a picosecond pulse duration laser with specialized optic for treatment of facial acne scarring. JAMA Dermatol. 2015;151:278–84.

    Article  PubMed  Google Scholar 

  241. Boen M, Jacob C. A review and update of treatment options using the Acne Scar Classification System. Dermatol Surg. 2019;45:411–22.

    Article  CAS  PubMed  Google Scholar 

  242. Nitayavardhana S, Wanitphakdeedecha R, Ng JNC, et al. The efficacy and safety of fractional radiofrequency nanoneedle system in the treatment of atrophic acne scars in Asians. J Cosmet Dermatol. 2020;19:1636–41.

    Article  PubMed  PubMed Central  Google Scholar 

  243. Goel A, Gatne V. Use of nanofractional radiofrequency for the treatment of acne scars in Indian skin. J Cosmet Dermatol. 2017;16:186–92.

    Article  PubMed  Google Scholar 

  244. Simmons BJ, Griffith RD, Falto-Aizpurua LA, et al. Use of radiofrequency in cosmetic dermatology: focus on nonablative treatment of acne scars. Clin Cosmet Investig Dermatol. 2014;7:335–9.

    Article  PubMed  PubMed Central  Google Scholar 

  245. Min S, Park SY, Yoon JY, et al. Comparison of fractional microneedling radiofrequency and bipolar radiofrequency on acne and acne scar and investigation of mechanism: comparative randomized controlled clinical trial. Arch Dermatol Res. 2015;307:897–904.

    Article  PubMed  Google Scholar 

  246. Katz BE. The fate of active acne and acne scars following treatment with fractional radiofrequency. J Drugs Dermatol. 2019;18:1268–72.

    CAS  PubMed  Google Scholar 

  247. Kacar N, Dursun R, Akbay M, et al. The early and late efficacy of single-pass fractional carbondioxide laser, fractional radiofrequency, and their combination in acne scars: a prospective, split-face, single-blinded, controlled clinical study. Dermatol Ther. 2020;33: e14444.

    Article  CAS  PubMed  Google Scholar 

  248. Tatliparmak A, Aksoy B, Shishehgarkhaneh LR, et al. Use of combined fractional carbon dioxide laser and fractional microneedle radiofrequency for the treatment of acne scars: a retrospective analysis of 1-month treatment outcome on scar severity and patient satisfaction. J Cosmet Dermatol. 2020;19:115–21.

    Article  PubMed  Google Scholar 

  249. Kim J, Lee YI, Kim J, et al. Safety of combined fractional microneedle radiofrequency and CO2 as an early intervention for inflammatory acne and scarring treated with concomitant isotretinoin. Dermatol Surg. 2020;46:e71–7.

    Article  CAS  PubMed  Google Scholar 

  250. Minh PPT, Bich DD, Hai VNT, et al. Microneedling therapy for atrophic acne scar: effectiveness and safety in Vietnamese patients. Open Access Maced J Med Sci. 2019;7:293–7.

    Article  PubMed  PubMed Central  Google Scholar 

  251. El-Domyati M, Barakat M, Awad S, et al. Microneedling therapy for atrophic acne scars: an objective evaluation. J Clin Aesthet Dermatol. 2015;8:36–42.

    PubMed  PubMed Central  Google Scholar 

  252. Dogra S, Yadav S, Sarangal R. Microneedling for acne scars in Asian skin type: an effective low cost treatment modality. J Cosmet Dermatol. 2014;13:180–7.

    Article  PubMed  Google Scholar 

  253. Cachafeiro T, Escobar G, Maldonado G, et al. Comparison of nonablative fractional erbium laser 1,340 nm and microneedling for the treatment of atrophic acne scars: a randomized clinical trial. Dermatol Surg. 2016;42:232–41.

    Article  CAS  PubMed  Google Scholar 

  254. Asif M, Kanodia S, Singh K. Combined autologous platelet-rich plasma with microneedling verses microneedling with distilled water in the treatment of atrophic acne scars: a concurrent split-face study. J Cosmet Dermatol. 2016;15:434–43.

    Article  PubMed  Google Scholar 

  255. Ibrahim MK, Ibrahim SM, Salem AM. Skin microneedling plus platelet-rich plasma versus skin microneedling alone in the treatment of atrophic post acne scars: a split face comparative study. J Dermatolog Treat. 2018;29:281–6.

    Article  PubMed  Google Scholar 

  256. Schoenberg E, O’Connor M, Wang JV, et al. Microneedling and PRP for acne scars: a new tool in our arsenal. J Cosmet Dermatol. 2020;19:112–4.

    Article  PubMed  Google Scholar 

  257. Rana S, Mendiratta V, Chander R. Efficacy of microneedling with 70% glycolic acid peel vs microneedling alone in treatment of atrophic acne scars: a randomized controlled trial. J Cosmet Dermatol. 2017;16:454–9.

    Article  PubMed  Google Scholar 

  258. Sharad J. Combination of microneedling and glycolic acid peels for the treatment of acne scars in dark skin. J Cosmet Dermatol. 2011;10:317–23.

    Article  PubMed  Google Scholar 

  259. Morelli Coppola M, Salzillo R, Segreto F, et al. Triamcinolone acetonide intralesional injection for the treatment of keloid scars: patient selection and perspectives. Clin Cosmet Investig Dermatol. 2018;11:387–96.

    Article  PubMed  PubMed Central  Google Scholar 

  260. Khan MA, Bashir MM, Khan FA. Intralesional triamcinolone alone and in combination with 5-fluorouracil for the treatment of keloid and hypertrophic scars. J Pak Med Assoc. 2014;64:1003–7.

    PubMed  Google Scholar 

  261. Waibel JS, Wulkan AJ, Shumaker PR. Treatment of hypertrophic scars using laser and laser assisted corticosteroid delivery. Lasers Surg Med. 2013;45:135–40.

    Article  PubMed  Google Scholar 

  262. Tawfik AA, Fathy M, Badawi A, et al. Topical 5 fluorouracil cream vs combined 5 fluorouracil and fractional erbium YAG laser for treatment of severe hypertrophic scars. Clin Cosmet Investig Dermatol. 2019;12:173–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  263. Waibel JS, Wulkan AJ, Rudnick A, et al. Treatment of hypertrophic scars using laser-sssisted corticosteroid versus laser-assisted 5-fluorouracil delivery. Dermatol Surg. 2019;45:423–30.

    Article  CAS  PubMed  Google Scholar 

  264. Beer K. A single-center, open-label study on the use of injectable poly-L-lactic acid for the treatment of moderate to severe scarring from acne or varicella. Dermatol Surg. 2007;33(Suppl. 2):S159–67.

    CAS  PubMed  Google Scholar 

  265. Rkein A, Ozog D, Waibel JS. Treatment of atrophic scars with fractionated CO2 laser facilitating delivery of topically applied poly-L-lactic acid. Dermatol Surg. 2014;40:624–31.

    CAS  PubMed  Google Scholar 

  266. Epstein RE, Spencer JM. Correction of atrophic scars with artefill: an open-label pilot study. J Drugs Dermatol. 2010;9:1062–4.

    PubMed  Google Scholar 

  267. Karnik J, Baumann L, Bruce S, et al. A double-blind, randomized, multicenter, controlled trial of suspended polymethylmethacrylate microspheres for the correction of atrophic facial acne scars. J Am Acad Dermatol. 2014;71:77–83.

    Article  CAS  PubMed  Google Scholar 

  268. Biesman BS, Cohen JL, DiBernardo BE, et al. Treatment of atrophic facial acne scars with microneedling followed by polymethylmethacrylate-collagen gel dermal filler. Dermatol Surg. 2019;45:1570–9.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We thank the Yale Department of Dermatology Resident Slide Collection for providing clinical images. We thank Drs. T. Orlowski, H.H. Reynolds, and L.V. Graham for providing clinical images of truncal demodicosis. This work was supported by the NIH/NIGMS Medical Scientist Training Grant T32GM136651 for SGD.

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Authors and Affiliations

  1. Medical Scientist Training Program, Yale School of Medicine, New Haven, CT, USA

    Stefano G. Daniele

  2. Department of Dermatology, Yale School of Medicine, New Haven, CT, USA

    Sa Rang Kim, Kathleen C. Suozzi & Christopher G. Bunick

  3. Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Ayman Grada

  4. Arlington Research Center, Arlington, TX, USA

    Angela Y. Moore

  5. Baylor University Medical Center, Dallas, TX, USA

    Angela Y. Moore

  6. Program in Translational Biomedicine, Yale School of Medicine, New Haven, CT, USA

    Christopher G. Bunick

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  1. Stefano G. Daniele
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  2. Sa Rang Kim
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  4. Angela Y. Moore
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Correspondence to Christopher G. Bunick.

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SGD, SRK, AG, and KCS have no disclosures; AYM has received funds, honoraria, or research grants as an advisory board member (A), consultant (C), clinical study investigator (I), and/or speaker (SP) for Almirall, Biofronterra, and Galderma; CGB has served as an (I) for Almirall; a (C) for AbbVie, Almirall, Arcutis, EpiHealth, LEO Pharma, Sanofi-Regeneron, and UCB; and a (SP) for and received honoraria from Allergan, Almirall, LEO Pharma, and UCB. These engagements did not influence the writing of this manuscript.

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Authors’ Contributions

SGD, SRK, AG, AYM, KCS, and CGB researched and/or provided data for the article. SGD and SRK wrote the first draft of the article. All authors contributed substantially to discussion of the content and reviewed and/or edited the manuscript before submission.

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Daniele, S.G., Kim, S.R., Grada, A. et al. Truncal Acne and Scarring: A Comprehensive Review of Current Medical and Cosmetic Approaches to Treatment and Patient Management. Am J Clin Dermatol 24, 199–223 (2023). https://doi.org/10.1007/s40257-022-00746-4

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