Treating Acne Vulgaris: Systemic, Local and Combination Therapy

Laura J Savage; Alison M Layton


Expert Rev Clin Pharmacol. 2010;13(4):563-580. 

In This Article

Abstract and Introduction


Optimizing the management of acne vulgaris corresponds with improved outcomes, reduced scarring and a positive influence on the profound psychosocial disability that frequently accompanies this debilitating skin condition. Many effective, cost-effective therapies are widely available, but significant improvement or clearance can only be achieved if these agents are employed with a logical approach. Patient variability makes the definition of optimum treatment strategies difficult, but with due consideration of the pathological mechanisms driving acne in each individual patient, an appropriate combination of topical, systemic and localized therapies can be prescribed that will yield a favorable outcome. In recent years, a range of physical techniques have emerged as an adjunct to conventional treatments, and with increasing patient interest and expectation, extensive research is underway into these and novel medical therapies that may further broaden our therapeutic armamentarium. This article provides details of currently available therapies, reviews the published evidence on efficacy and considers how best to optimize outcomes with a focus on acne pathogenesis.


Acne is a multifactorial inflammatory disease of the pilosebaceous follicle, predominantly involving the skin of the face and trunk. The pathophysiology of acne is slowly unraveling, and although many factors remain undetermined, a better understanding of the mechanisms involved has led to an improvement in acne management over the last decade. Four key factors have been identified in the etiology of acne: increased sebum production, follicular hyperkeratinization, colonization of the pilosebaceous unit with Propionibacterium acnes and the production of inflammation. Acne needs to be managed aggressively from the outset using a combination of treatments directed against each of the relevant factors. However, defining optimum treatment strategies remains difficult as significant variability exists between individuals, both in terms of clinical presentation and response to treatment. This article reviews the treatments that are currently available and considers how best to optimize management and outcomes.


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