Overview of New Therapeutic Developments for Acne

Anja Thielitz; Harald Gollnick

Disclosures

April 13, 2009

In This Article

Abstract and Introduction

Abstract

The pathogenesis of acne is complex and multifactorial, and parallel targeting of various pathogenetic factors with appropriate drugs currently represents the most effective approach for treating this psychologically and physically scarring disease. Current therapeutic developments in acne focus on fixed combinations of substances with complementary effects in order to optimize efficacy and improve patient compliance. Such combinations are topical clindamycin with benzoyl peroxide, an approach that also reduces the emergence of resistant strains of Propionibacterium acnes, as well as the fixed combination of retinoids with antimicrobials, namely a clindamycin phosphate 1.2%/tretinoin 0.025% and an adapalene 0.1%/benzoyl peroxide 2.5% gel combination. Recent studies have demonstrated the clinical efficacy of topical retinoids in maintenance therapy of acne, which supports the currently refined understanding of acne as a chronic disease. New approaches addressed in clinical trials include topical dapsone 5% or triethyl citrate and ethyl linoleate. This review summarizes new therapeutic drug developments and strategies in mild-to-moderate or severe acne during the last 5 years.

Introduction

Acne is an extremely common disease with a prevalence of up to 80-90% among adolescents and continues to be a common skin problem past teenage years.[1,2] It can be a devastating disease for the patient since it manifests on visible body parts and particularly in adolescents, at a time when self-esteem is vulnerable both socially and psychologically. To prevent physical or psychological scarring, as many as 15-30% of patients with acne need intense medical specialist treatment, thus representing the largest patient group seen by dermatologists worldwide. Acne usually lasts several years in the affected individual and represents a condition that continuously changes in its clinical appearance rather than an acute disease. Currently, the understanding of acne has been refined toward a 'chronic disease', overcoming the misconception of acne as a simple, self-limited affliction of adolescents.[3]

Over the last 25 years, the groups of substances used for acne therapy have remained relatively constant and comprise mainly topical and systemic antimicrobials and retinoids, although, within these groups, considerable improvements have been achieved with regard to the development of new compounds or delivery systems with better efficacy and tolerability. Research during recent years has refined our understanding of the complex immunopathophysiology of this disease; however, our knowledge regarding the sequence of events leading to acne initiation and events involved in acne termination is still incomplete and is the subject of controversial discussion and ongoing research.[4,5]

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