Acne vulgaris, an inflammatory disease of the pilosebaceous unit of the skin, is commonly found in the face and trunk regions. It is prevalent in approximately 9% of the population globally, with nearly 85% of individuals in age between 12-24 years, and nearly 50% of patients between 20-29 years of age. 

It is associated with permanent physical scarring, reduced quality of life and self-image, increased rates of anxiety, depression, and suicidal ideation.

A study described the following about acne vulgaris-

• Acne vulgaris is categorized according to-
• The age of the patient,
• Lesion morphology (comedonal, inflammatory, mixed, nodulocystic),
• Distribution (location on face, trunk, or both),
• Severity (extent, presence or absence of scarring, postinflammatory erythema, or hyperpigmentation). 

Specific medical evaluation is not required in the majority of the cases, while some may require medical workup. 

The first-line treatment remains topical therapies like retinoids (eg, tretinoin, adapalene), benzoyl peroxide, azelaic acid, and/or combinations of topical agents. 

A randomized trial including 207 patients rendered a single therapy treatment with tretinoin 0.025% gel and observed a 63% reduction in acne lesion counts at 12 weeks contrasting baseline. 

Severe cases demand combinations of topical agents with systemic agents (oral antibiotics such as doxycycline and minocycline, hormonal therapies such as combination oral contraception [COC] or spironolactone, or isotretinoin).

A meta-analysis including 32 randomized clinical trials, described 62% reductions in inflammatory lesions by COC, 26% reduction by placebo and 58% reduction by oral antibiotics, at 6-month follow-up. 

The US Food and Drug Administration approves Isotretinoin for treating severe recalcitrant nodular acne.

Isotretinoin is frequently employed for treating resistant or persistent moderate to severe acne, and acne associated with scarring or significant psychosocial distress.

Source: Eichenfield DZ, Sprague J, Eichenfield LF. Management of Acne Vulgaris: A Review. JAMA. 2021 Nov 23;326(20):2055-2067. doi: 10.1001/jama.2021.17633. PMID: 34812859.