Pharmacologic Treatment of Acne

ABSTRACT

Acne is one of the most common skin diseases. It usually occurs during adolescence, but can persist into middle age. The most deleterious form can result in permanent scarring on the face, chest, and back. The pathogenesis of acne is thought to be multifactorial. There are four most significant pathogenic factors of acne Androgen-stimulated production of sebum, hyperkeratinization and obstruction of sebaceous follicles, proliferation of Propionibacterium acnes and inflammation. Therefore, pharmacologic treatment of acne should be focused on at least one of these main causative factors. The ultimate goal of treatment is to address as many of the pathogenic factors of acne as possible while minimizing side effects. Topical retinoids correct abnormal keratinization, but it should be applied cautiously because of irritation. Benzoyl peroxide is an effective bactericidal agent against P. acnes. Main topical antibiotics are erythromycin and clindamycin. Recently, fixed combination topical products have been highlighted. Use of Systemic antibiotics, including tetracyclines and macrolides rapidly improves inflammatory acne lesions. Oral isotretinoin is effective against all of the pathogenic features of acne but is contraindicated in pregnant women and has been associated with elevations in triglyceride levels, cheilitis and dry skin. Hormonal therapy has been found to improve acne in some women and should be considered for appropriate candidates. Because acne is a complex multifactorial disorder, combination treatment may be required to target its various pathogenic factors. Combination treatments also offer the most improvement over the shortest time. This review provides a general overview of pharmacologic treatment of acne.