Acne vulgaris is an inflammatory disease of the pilosebaceous unit of the skin that predominantly involves the face and trunk and affects approximately 9% of the population globally. Nearly 85% of individuals aged 12 to 24 years and approximately 50% of patients aged 20to 29 years are affected. Acne vulgaris can result in permanent physical scarring, negatively affect the quality of life and self-image, and is present with increased rates of anxiety, depression and suicidal ideation.

Acne vulgaris is classified according to patient age, lesion morphology (comedonal, inflammatory, mixed, nodulocystic), distribution (location on face, trunk or both) and severity (extent, presence or absence of scarring, post-inflammatory erythema or hyperpigmentation). Although most acne does not require specific medical evaluation, it may be required in some cases. 

The first-line treatment for the management includes topical therapies such as retinoids (e.g., tretinoin, adapalene), benzoyl peroxide, azelaic acid and/or combinations of topical agents. A single therapy with tretinoin 0.025% gel showed a reduction in acne lesion counts at 12 weeks by 63% compared with baseline. Combinations of topical agents with systemic agents (oral antibiotics like doxycycline and minocycline, hormonal therapies like combination oral contraception [COC] or spironolactone or isotretinoin) are recommended for more severe diseases. A meta-analysis of 32 randomized clinical trials showed COC to be associated with reductions in inflammatory lesions by 62%, placebo to be associated with a 26% reduction and oral antibiotics to be associated with a 58% reduction at a 6-month follow-up. Isotretinoin is approved by the US Food and Drug Administration for the treatment of severe recalcitrant nodular acne but is often used to treat resistant or persistent moderate-to-severe acne, as well as acne that produces scarring or significant psychosocial distress.

Source: Eichenfield DZ, Sprague J, Eichenfield LF. Management of acne vulgaris: areview. JAMA. 2021;326(20):2055-67.