Some dermatologists may be surprised to hear that the concept of teledermatology originated 25 years ago, and has slowly increased in usage, primarily for the purpose of providing care to those in underserved areas.¹ The challenges created by the COVID19 pandemic has rapidly accelerated both interest and usage of telemedicine by dermatologists, with the American Academy of Dermatology and other dedicated groups responding quickly to provide guidance on how to integrate teledermatology into real-world dermatology practice effectively, and hopefully with avoidance of technical, medicolegal, and financial pitfalls.² Despite differences in opinion on whether teledermatology is beneficial to the specialty, it does provide some positive aspects for patients such as decreased travel time, faster access to care, and ability to reach underserved geographic areas. On the other hand, there are many challenges related to completeness of the visit, quality of images, legal considerations, individual state regulations, security issues, lack of a true sense of connection between the patient and clinician, and conflicts in management due to patients who independently seek care from multiple clinicians simultaneously. Marked efforts are also being made to assure proper education on coding and billing for teledermatology services.^2,3

Of the four primary pathogenic factors that drive acne vulgaris—androgen excess, increased sebum production, faulty keratinization, and overgrowth of C. acnes—androgen excess has been the most elusive therapeutic target. Oral contraceptive pills (OCPs) have direct effect on circulating hormones, but their potential use is limited to a subset of women. As such, a sizable portion of the population affected by acne vulgaris cannot even consider treatment with OCPs. While these systemic agents are generally associated with a low risk profile and have a history of safe and effective use, they are not entirely risk-free. Indirect androgen modulation with drugs has become increasingly popular. Again, while generally safe and effective, this systemic treatment is not without risks and contraindications and it is also limited to a subset of female patients.

Topical treatment is the mainstay of acne therapy. Despite their effectiveness in treating mild to moderate acne vulgaris, these topical medications are found to be irritating, and are historically associated with poor tolerability and diminished patient adherence. Thus, choosing the right formulation that will be effective and well tolerated is essential. Novel formulations that optimize drug concentration and utilize improved delivery vehicles have helped to enhance the tolerability and efficacy, and allow for less frequent application or co-application of drugs that were previously considered incompatible. This article will review the goals of topical therapy for the treatment of acne, in addition to common therapies and their challenges. Advanced formulations and new combination formulations will also be discussed. J Drugs Dermatol. 2018;17(6 Suppl):s6-10.

Over more than four decades, the drug that launched the retinoid class into the market has been used in the topical management of acne, either alone or in combination. In fact, current consensus acne treatment guidelines rely heavily on retinoids, as they address several aspects of acne pathogenesis— they are comedolytic, resolve the precursor microcomedone, and are anti-inflammatory— without posing any risk for antibiotic resistance.

 There is a need for new oral antibiotics for acne with improved safety profiles and targeted antibacterial spectra. Sarecycline is a novel, tetracycline-class antibiotic specifically designed for acne, offering a narrow spectrum of activity compared with currently available tetracyclines, including less activity against enteric Gram-negative bacteria. This phase 2 study evaluated the efficacy and safety of three doses of sarecycline for moderate to severe facial acne vulgaris.