Overview of New Therapeutic Developments for Acne

Anja Thielitz; Harald Gollnick


April 13, 2009

In This Article

Acne Therapy Guidelines

The most notable pathophysiologic factors influencing the development of acne are sebaceous gland hyperplasia with hyperseborrhea, alterations in the growth and differentiation of follicular keratinocytes, Propionibacterium acnes colonization of the follicle as well as inflammation and immune reactions.

Clinical experience and evidence of various studies have shown that parallel targeting of these major pathogenetic factors, depending on clinical type and severity either by monotherapy or, even better, combination therapy, currently represents the most effective approach for treating acne.[6,7]

Topical antimicrobial agents or topical retinoids are used commonly as first-line agents for the management of mild-to-moderate acne vulgaris. Their combination significantly enhances anti-acne efficacy and leads to a faster onset of clinical improvement. Recent therapeutic developments in acne have focused on fixed combinations of substances with complementary effects in order to optimize efficacy and improve patient compliance.

In severe or refractory cases, the combination of nonantibiotic topical agents with systemic antibiotics (doxycycline, minocycline, tetracycline, lymecycline and macrolides), which work via antimicrobial, anti-inflammatory and immunomodulatory modes of action, is necessary. Other systemic acne treatments include hormonal therapies (anti-androgens, combined oral contraceptives and glucocorticoids) or oral isotretinoin (13-cis-retinoic acid).[7]

Systemic isotretinoin as a monotherapeutic agent is the most potent inhibitor of sebum production and affects all four major pathogenetic factors, which renders this compound uniquely effective in the treatment of severe recalcitrant nodulocystic acne and in the prevention of acne scarring. Although it has been a potent and safe agent in the hands of experienced dermatologists for more than 20 years, the use of isotretinoin has experienced a drawback since its indication has been changed from a first-line to a second-line medication, which was launched by the European Commission and the EMEA directive toward the harmonization of the Summary of Product Characteristics.


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