Newer Approaches to the Treatment of Acne Vulgaris

Abstract

The multifactorial etiology of acne vulgaris makes it challenging to treat. Current treatments include topical retinoids, benzoyl peroxide, topical and systemic antibiotics, azelaic acid, and systemic isotretinoin. Adjunctive and/or emerging approaches include topical dapsone, taurine bromamine, resveratrol, chemical peels, optical treatments, as well as complementary and alternative medications. The purpose of this paper is to discuss the therapies available for acne and their latest developments, including new treatment strategies (i.e. re-evaluation of the use of oral antibiotics and avoidance of topical antibiotic monotherapy, use of subantimicrobial antibiotic dosing, use of low-dose isotretinoin, optical treatments), new formulations (microsponges, liposomes, nanoemulsions, aerosol foams), new combinations (fixed-combination products of topical retinoids and topical antibiotics [essentially clindamycin] or benzoyl peroxide), new agents (topical dapsone, taurine bromamine, resveratrol) and their rationale and likely place in treatment. Acne vaccines, topical natural antimicrobial peptides, and lauric acid represent other promising therapies.

This is a preview of subscription content, access via your institution.

Table I

References

  1. 1.

    Kim RH, Armstrong AW. Current state of acne treatment: highlighting lasers, photodynamic therapy, and chemical peels. Dermatol Online J 2011 Mar; 17(3): 2

    PubMed  Google Scholar 

  2. 2.

    Williams HC, Dellavalle RP, Garner S. Acne vulgaris. Lancet 2012 Jan 28; 379(9813): 361–72

    PubMed  Article  Google Scholar 

  3. 3.

    Ghodsi SZ, Orawa H, Zouboulis CC. Prevalence, severity, and severity risk factors of acne in high school pupils: a community-based study. J Invest Dermatol 2009 Sep; 129(9): 2136–41

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Dréno Recent data on epidemiology of acne [in French]. Ann Dermatol Venereol 2010 Nov; 137 Suppl. 2: S49–51

    Google Scholar 

  5. 5.

    Goçalves G, Amado J, Matos M, et al. The prevalence of acne among a group of Portuguese medical students. J Eur Acad Dermatol Venereol 2012 Apr; 26(4): 514–7

    Article  Google Scholar 

  6. 6.

    Perkins AC, Maglione J, Hillebrand GG, et al. Acne vulgaris in women: prevalence across the life span. J Womens Health (Larchmt) 2012 Feb; 21(2): 223–30

    Article  Google Scholar 

  7. 7.

    Golchai J, Khani SH, Heidarzadeh A, et al. Comparison of anxiety and depression in patients with acne vulgaris and healthy individuals. Indian J Dermatol 2010 Oct; 55(4): 352–4

    PubMed  Article  Google Scholar 

  8. 8.

    Dunn LK, O’Neill JL, Feldman SR. Acne in adolescents: quality of life, self-esteem, mood, and psychological disorders. Dermatol Online J 2011 Jan 15; 17(1):1

    PubMed  Google Scholar 

  9. 9.

    Gollnick H, Cunliffe W, Berson D, et al., Global Alliance to Improve Outcomes in Acne. Management of acne: a report from a Global Alliance to Improve Out-comes in Acne. J Am Acad Dermatol 2003 Jul; 49 (1 Suppl.): S1–37

    PubMed  Article  Google Scholar 

  10. 10.

    Strauss JS, Krowchuk DP, Leyden JJ, et al. Guidelines of care for acne vulgaris management. J Am Acad Dermatol 2007 Apr; 56(4): 651–63

    PubMed  Article  Google Scholar 

  11. 11.

    Dréno Bettoli V, Ochsendorf F, et al. European recommendations on the use of oral antibiotics for acne. Eur J Dermatol 2004 Nov–Dec; 14 (6): 391–9

    Google Scholar 

  12. 12.

    Nast A, Bayerl C, Borelli C, et al. S2k-guideline for therapy of acne [in German]. J Dtsch Dermatol Ges 2010 Jul; 8 Suppl. 2: s1–59

    PubMed  Google Scholar 

  13. 13.

    Thielitz A, Gollnick H. Topical retinoids in acne vulgaris: update on efficacy and safety. Am J Clin Dermatol 2008; 9(6): 369–81

    PubMed  Article  Google Scholar 

  14. 14.

    Yentzer BA, McClain RW, Feldman SR. Do topical retinoids cause acne to“flare”? J Drugs Dermatol 2009 Sep; 8_(9): 799–801

    Google Scholar 

  15. 15.

    Gollnick HP, Finlay AY, Shear N. Can we define acne as a chronic disease? If so, how and when? Am J Clin Dermatol 2008; 9_(5): 279–84

    Article  Google Scholar 

  16. 16.

    Cunliffe WJ, Poncet M, Loesche C, et al. A comparison of the efficacy and tolerability of adapalene 0.1% gel versus tretinoin 0.025% gel in patients with acne vulgaris: a meta-analysis of five randomized trials. Br J Dermatol 1998 Oct; 139 Suppl. 52: 48–56

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Eichenfield LF, Wortzman M. A novel gel formulation of 0.25% tretinoin and 1.2% clindamycin phosphate: efficacy in acne vulgaris patients aged 12 to 18 years. Pediatr Dermatol 2009 May–Jun; 26(3): 257–61

    PubMed  Article  Google Scholar 

  18. 18.

    Webster GF. Evidence-based review: fixed-combination therapy and topical retinoids in the treatment of acne. J Drugs Dermatol 2011 Jun; 10(6): 636–44

    PubMed  Google Scholar 

  19. 19.

    Eichenfield LF, Alió Sáenz AB. Safety and efficacy of clindamycin phosphate 1.2%-benzoyl peroxide 3% fixed-dose combination gel for the treatment of acne vulgaris: a phase 3, multicenter, randomized, double-blind, active- and vehicle-controlled study. J Drugs Dermatol 2011 Dec 1; 10(12): 1382–96

    PubMed  CAS  Google Scholar 

  20. 20.

    Gold LS, Tan J, Cruz-Santana A, et al. A North American study of adapalene- benzoyl peroxide combination gel in the treatment of acne. Cutis 2009 Aug; 84(2): 110–6

    PubMed  Google Scholar 

  21. 21.

    Lucky AW, Sugarman J. Comparison of micronized tretinoin gel 0.05% and tretinoin gel microsphere 0.1% in young adolescents with acne: a post hoc analysis of efficacy and tolerability data. Cutis 2011 Jun; 87(6): 305–10

    PubMed  Google Scholar 

  22. 22.

    Torok HM, Pillai R. Safety and efficacy of micronized tretinoin gel (0.05%) in treating adolescent acne. J Drugs Dermatol 2011 Jun; 10(6): 647–52

    PubMed  Google Scholar 

  23. 23.

    Castro GA, Oliveira CA, Mahecha GA, et al. Comedolytic effect and reduced skin irritation of a new formulation of all-trans retinoic acid-loaded solid lipid nanoparticles for topical treatment of acne. Arch Dermatol Res 2011 Sep; 303(7): 513–20

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    Lee HE, Ko JY, Kim YH, et al. A double-blind randomized controlled comparison of APDDR-0901, a novel cosmeceutical formulation, and 0.1% adapalene gel in the treatment of mild-to-moderate acne vulgaris. Eur J Dermatol 2011 Nov–Dec; 21(6): 959–65

    PubMed  CAS  Google Scholar 

  25. 25.

    Ganceviciene R, Zouboulis CC. Isotretinoin: state of the art treatment for acne vulgaris. J Dtsch Dermatol Ges 2010 Mar; 8 Suppl. 1: S47–59

    PubMed  Google Scholar 

  26. 26.

    Rigopoulos D, Larios G, Katsambas AD. The role of isotretinoin in acne therapy: why not as first-line therapy? Facts and controversies. Clin Dermatol 2010 Jan–Feb; 28(1): 24–30

    PubMed  Article  Google Scholar 

  27. 27.

    Agarwal US, Besarwal RK, Bhola K. Oral isotretinoin in different dose regimens for acne vulgaris: a randomized comparative trial. Indian J Dermatol Venereol Leprol 2011 Nov-Dec; 77(6): 688–94

    PubMed  Article  Google Scholar 

  28. 28.

    Lee JW, Yoo KH, Park KY, et al. Effectiveness of conventional, low-dose and intermittent oral isotretinoin in the treatment of acne: a randomized, controlled comparative study. Br J Dermatol 2011 Jun; 164(6): 1369–75

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Bernstein CN, Nugent Z, Longobardi T, et al. Isotretinoin is not associated with inflammatory bowel disease: a population-based case-control study. Am J Gastroenterol 2009 Nov; 104(11): 2774–8

    PubMed  Article  CAS  Google Scholar 

  30. 30.

    Crockett SD, Porter CQ, Martin CF, et al. Isotretinoin use and the risk of inflammatory bowel disease: a case-control study. Am J Gastroenterol 2010 Sep; 105(9): 1986–93

    PubMed  Article  Google Scholar 

  31. 31.

    Marqueling AL, Zane LT. Depression and suicidal behavior in acne patients treated with isotretinoin: a systematic review. Semin Cutan Med Surg 2007 Dec; 26(4): 210–20

    PubMed  Article  CAS  Google Scholar 

  32. 32.

    Halvorsen JA, Stern RS, Dalgard F, et al. Suicidal ideation, mental health problems, and social impairment are increased in adolescents with acne: a population-based study. J Invest Dermatol 2011 Feb; 131(2): 363–70

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    Langan SM, Batchelor JM. Acne, isotretinoin and suicide attempts: a critical appraisal. Br J Dermatol 2011 Jun; 164(6): 1183–5

    PubMed  Article  CAS  Google Scholar 

  34. 34.

    Sundström A, Alfredsson L, Sjölin-Forsberg G, et al. Association of suicide attempts with acne and treatment with isotretinoin: retrospective Swedish cohort study. BMJ 2010 Nov 11; 341: c5812

    PubMed  Article  Google Scholar 

  35. 35.

    Lowenstein EB, Lowenstein EJ. Isotretinoin systemic therapy and the shadow cast upon dermatology’s downtrodden hero. Clin Dermatol 2011 Nov–Dec; 29(6): 652–61

    Article  Google Scholar 

  36. 36.

    Ross JI, Snelling AM, Carnegie E, et al. Antibiotic-resistant acne: lessons from Europe. Br J Dermatol 2003 Mar; 148(3): 467–78

    PubMed  Article  CAS  Google Scholar 

  37. 37.

    Simonart T, Dramaix M. Treatment of acne with topical antibiotics: lessons from clinical studies. Br J Dermatol 2005 Aug; 153(2): 395–403

    PubMed  Article  CAS  Google Scholar 

  38. 38.

    Thiboutot D, Gollnick H, Bettoli V, et al. New insights into the management of acne: an update from the Global Alliance to Improve Outcomes in Acne group. J Am Acad Dermatol 2009 May; 60 (5 Suppl.): S1–50

    PubMed  Article  Google Scholar 

  39. 39.

    Ozolins M, Eady EA, Avery AJ, et al. Comparison of five antimicrobial regimens for treatment of mild to moderate inflammatory facial acne vulgaris in the community: randomised controlled trial. Lancet 2004 Dec 18–31; 364(9452): 2188–95

    PubMed  Article  CAS  Google Scholar 

  40. 40.

    Simonart T, Dramaix M, De Maertelaer V. Efficacy of tetracyclines in the treatment of acne vulgaris: a review. Br J Dermatol 2008 Feb; 158(2): 208–16

    PubMed  CAS  Google Scholar 

  41. 41.

    Ochsendorf F. Minocycline in acne vulgaris: benefits and risks. Am J Clin Dermatol 2010; 11(5): 327–41

    PubMed  Article  Google Scholar 

  42. 42.

    Skidmore R, Kovach R, Walker C, et al. Effects of subantimicrobial-dose doxycycline in the treatment of moderate acne. Arch Dermatol 2003 Apr; 139(4): 459–64

    PubMed  Article  CAS  Google Scholar 

  43. 43.

    Toossi P, Farshchian M, Malekzad F, et al. Subantimicrobial-dose doxycycline in the treatment of moderate facial acne. J Drugs Dermatol 2008 Dec; 7(12): 1149–52

    PubMed  Google Scholar 

  44. 44.

    Brandstetter AJ, Maibach HI. Topical dose justification: benzoyl peroxide concentrations. J Dermatolog Treat. Epub 2011 Dec 27

  45. 45.

    Hughes BR, Norris JF, Cunliffe WJ. A double-blind evaluation of topical isotretinoin 0.05%, benzoyl peroxide gel 5% and placebo in patients with acne. Clin Exp Dermatol 1992 May; 17(3): 165–8

    PubMed  Article  CAS  Google Scholar 

  46. 46.

    Harper JC. Benzoyl peroxide development, pharmacology, formulation and clinical uses in topical fixed-combinations. J Drugs Dermatol 2010 May; 9(5): 482–7

    PubMed  Google Scholar 

  47. 47.

    Choudhury S, Chatterjee S, Sarkar DK, et al. Efficacy and safety of topical nadifloxacin and benzoyl peroxide versus clindamycin and benzoyl peroxide in acne vulgaris: a randomized controlled trial. Indian J Pharmacol 2011 Nov; 43(6): 628–31

    PubMed  CAS  Google Scholar 

  48. 48.

    Seidler EM, Kimball AB. Meta-analysis comparing efficacy of benzoyl peroxide, clindamycin, benzoyl peroxide with salicylic acid, and combination benzoyl peroxide/clindamycin in acne. J Am Acad Dermatol 2010 Jul; 63(1): 52–62

    PubMed  Article  CAS  Google Scholar 

  49. 49.

    Gollnick HP, Graupe Zaumseil RP. Azelaic acid 15% gel in the treatment of acne vulgaris: combined results of two double-blind clinical comparative studies [in German]. J Dtsch Dermatol Ges 2004 Oct; 2(10): 841–7

    PubMed  Article  Google Scholar 

  50. 50.

    Stinco G, Bragadin G, Trotter D, et al. Relationship between sebostatic activity, tolerability and efficacy of three topical drugs to treat mild to moderate acne. J Eur Acad Dermatol Venereol 2007 Mar; 21(3): 320–5

    PubMed  Article  CAS  Google Scholar 

  51. 51.

    Katsambas A, Graupe Stratigos J. Clinical studies of 20% azelaic acid cream in the treatment of acne vulgaris: comparison with vehicle and topical tretinoin. Acta Derm Venereol Suppl (Stockh) 1989; 143: 35–9

    CAS  Google Scholar 

  52. 52.

    Stotland M, Shalita AR, Kissling RF. Dapsone 5% gel: a review of its efficacy and safety in the treatment of acne vulgaris. Am J Clin Dermatol 2009; 10(4): 221–7

    PubMed  Article  Google Scholar 

  53. 53.

    Pickert A, Raimer S. An evaluation of dapsone gel 5% in the treatment of acne vulgaris. Expert Opin Pharmacother 2009 Jun; 10(9): 1515–21

    PubMed  Article  CAS  Google Scholar 

  54. 54.

    Kircik LH. Harnessing the anti-inflammatory effects of topical dapsone for management of acne. J Drugs Dermatol 2010 Jun; 9(6): 667–71

    PubMed  Google Scholar 

  55. 55.

    Marcinkiewicz J, Wojas-Pelc A, Walczewska M, et al. Topical taurine bromamine, a new candidate in the treatment of moderate inflammatory acne vulgaris: a pilot study. Eur J Dermatol 2008 Jul–Aug; 18(4): 433–9

    PubMed  CAS  Google Scholar 

  56. 56.

    Dréno Fischer TC, Perosino E, et al. Expert opinion: efficacy of superficial chemical peels in active acne management: what can we learn from the literature today? Evidence-based recommendations. J Eur Acad Dermatol Venereol 2011 Jun; 25(6): 695–704

    Article  Google Scholar 

  57. 57.

    Takenaka Y, Hayashi N, Takeda M, et al. Glycolic acid chemical peeling improves inflammatory acne eruptions through its inhibitory and bactericidal effects on Propionibacterium acnes. J Dermatol 2012 Apr; 39(4): 350–4

    PubMed  Article  CAS  Google Scholar 

  58. 58.

    Akarsu S, Fetil E, Yücel F, et al. Efficacy of the addition of salicylic acid to clindamycin and benzoyl peroxide combination for acne vulgaris. J Dermatol 2012 May; 39(5): 433–8

    PubMed  Article  CAS  Google Scholar 

  59. 59.

    Del Rosso JQ. The use of sodium sulfacetamide 10%-sulfur 5% emollient foam in the treatment of acne vulgaris. J Clin Aesthet Dermatol 2009 Aug; 2(8): 26–9

    Google Scholar 

  60. 60.

    Fabbrocini G, Staibano S, De Rosa G, et al. Resveratrol-containing gel for the treatment of acne vulgaris: a single-blind, vehicle-controlled, pilot study. Am J Clin Dermatol 2011 Apr 1; 12(2): 133–41

    PubMed  Article  Google Scholar 

  61. 61.

    Arowojolu Gallo MF, Lopez LM, et al. Combined oral contraceptive pills for treatment of acne. Cochrane Database Syst Rev 2009 Jul; 8(3): CD004425

    Google Scholar 

  62. 62.

    Guerra-Tapia A, Sancho Pérez Ethinylestradiol/chlormadinone acetate: dermatological benefits. Am J Clin Dermatol 2011 Sep 6; 12 Suppl. 1:3–11

    PubMed  Article  Google Scholar 

  63. 63.

    Frangos JE, Alavian CN, Kimball AB. Acne and oral contraceptives: update on women’s health screening guidelines. J Am Acad Dermatol 2008 May; 58(5): 781–6

    PubMed  Article  Google Scholar 

  64. 64.

    Brown J, Farquhar C, Lee O, et al. Spironolactone versus placebo or in combination with steroids for hirsutism and/or acne. Cochrane Database Syst Rev 2009 Apr 15; (2): CD000194

    PubMed  Google Scholar 

  65. 65.

    Gribbon EM, Shoesmith JG, Cunliffe WJ, et al. The microaerophily and photosensitivity of Propionibacterium acnes. J Appl Bacteriol 1994 Nov; 77(5): 583–90

    PubMed  Article  CAS  Google Scholar 

  66. 66.

    Ross EV. Optical treatments for acne. Dermatol Ther 2005 May–Jun; 18 (3): 253–66

    PubMed  Article  Google Scholar 

  67. 67.

    Papageorgiou P, Katsambas A, Chu A. Phototherapy with blue (415 nm) and red (660 nm) light in the treatment of acne vulgaris. Br J Dermatol 2000 May; 142(5): 973–8

    PubMed  Article  CAS  Google Scholar 

  68. 68.

    Tzung TY, Wu KH, Huang ML. Blue light phototherapy in the treatment of acne. Photodermatol Photoimmunol Photomed 2004 Oct; 20(5): 266–9

    PubMed  Article  Google Scholar 

  69. 69.

    Haedersdal M, Togsverd-Bo K, Wulf HC. Evidence-based review of lasers, light sources and photodynamic therapy in the treatment of acne vulgaris. J Eur Acad Dermatol Venereol 2008 Mar; 22(3): 267–78

    PubMed  Article  CAS  Google Scholar 

  70. 70.

    Hamilton FL, Car J, Lyons C, et al. Laser and other light therapies for the treatment of acne vulgaris: systematic review. Br J Dermatol 2009 Jun; 160(6): 1273–85

    PubMed  Article  CAS  Google Scholar 

  71. 71.

    Jih MH, Kimyai-Asadi A. Laser treatment of acne vulgaris. Semin Plast Surg 2007 Aug; 21(3): 167–74

    PubMed  Article  Google Scholar 

  72. 72.

    Gold MH, Biron J. Efficacy of a novel combination of pneumatic energy and broadband light for the treatment of acne. J Drugs Dermatol 2008 Jul; 7(7): 639–42

    PubMed  Google Scholar 

  73. 73.

    Shamban AT, Enokibori M, Narurkar V, et al. Photopneumatic technology for the treatment of acne vulgaris. J Drugs Dermatol 2008 Feb; 7(2): 139–45

    PubMed  Google Scholar 

  74. 74.

    Reuter J, Merfort I, Schempp CM. Botanicals in dermatology: an evidence-based review. Am J Clin Dermatol 2010; 11(4): 247–67

    PubMed  Google Scholar 

  75. 75.

    Simonart T, Kabagabo De Maertelaer V. Homoeopathic remedies in dermatology: a systematic review of controlled clinical trials. Br J Dermatol 2011 Oct; 165(4): 897–905

    PubMed  Article  CAS  Google Scholar 

  76. 76.

    Magin PJ, Adams J, Pond CD, et al. Topical and oral CAM in acne: a review of the empirical evidence and a consideration of its context. Complement Ther Med 2006 Mar; 14(1): 62–76

    PubMed  Article  CAS  Google Scholar 

  77. 77.

    Simpson RC, Grindlay DJ, Williams HC. What’s new in acne? An analysis of systematic reviews and clinically significant trials published in 2010–11. Clin Exp Dermatol 2011 Dec; 36(8): 840–3

    PubMed  Article  CAS  Google Scholar 

  78. 78.

    Koku Aksu AE, Metintas S, Saracoglu ZN, et al. Acne: prevalence and relationship with dietary habits in Eskisehir, Turkey. J Eur Acad Dermatol Venereol. Epub 2011 Nov 10

  79. 79.

    Veith WB, Silverberg NB. The association of acne vulgaris with diet. Cutis 2011 Aug; 88(2): 84–91

    PubMed  Google Scholar 

  80. 80.

    Cordain L, Lindeberg S, Hurtado M, et al. Acne vulgaris: a disease of Western civilization. Arch Dermatol 2002 Dec; 138(12): 1584–90

    PubMed  Article  Google Scholar 

  81. 81.

    Smith RN, Mann NJ, Braue A, et al. The effect of a high-protein, low glycemic-load diet versus a conventional, high glycemic-load diet on biochemical parameters associated with acne vulgaris: a randomized, investigator-masked, controlled trial. J Am Acad Dermatol 2007 Aug; 57(2): 247–56

    PubMed  Article  Google Scholar 

  82. 82.

    Danby FW. Nutrition and acne. Clin Dermatol 2010 Nov–Dec; 28(6): 598–604

    Article  Google Scholar 

  83. 83.

    Kim J. Acne vaccines: therapeutic option for the treatment of acne vulgaris? J Invest Dermatol 2008 Oct; 128(10): 2353–4

    PubMed  Article  CAS  Google Scholar 

  84. 84.

    Rubinchik E, Dugourd D, Algara T, et al. Antimicrobial and antifungal activities of a novel cationic antimicrobial peptide, omiganan, in experimental skin colonisation models. Int J Antimicrob Agents 2009 Nov; 34(5): 457–61

    PubMed  Article  CAS  Google Scholar 

  85. 85.

    Wang Y, Zhang Z, Chen L, et al. Cathelicidin-BF, a snake cathelicidin-derived antimicrobial peptide, could be an excellent therapeutic agent for acne vulgaris. PLoS ONE 2011; 6(7): e22120

    PubMed  Article  CAS  Google Scholar 

  86. 86.

    Nakatsuji T, Kao MC, Fang JY, et al. Antimicrobial property of lauric acid against Propionibacterium acnes: its therapeutic potential for inflammatory acne vulgaris. J Invest Dermatol 2009 Oct; 129(10): 2480–8

    PubMed  Article  CAS  Google Scholar 

Download references

Acknowledgments

No sources of funding were used to prepare this article. The author has no conflicts of interest that are directly relevant to the content of this article.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Dr Thierry Simonart.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Simonart, T. Newer Approaches to the Treatment of Acne Vulgaris. Am J Clin Dermatol 13, 357–364 (2012). https://doi.org/10.2165/11632500-000000000-00000

Download citation

Keywords

  • Resveratrol
  • Acne
  • Isotretinoin
  • Benzoyl Peroxide
  • Tretinoin