INTRODUCTION
Acne is one of the most prevalent dermatological conditions, affecting millions worldwide. It not only has a significant physical impact, but also contributes to psychological distress, including low self-esteem and depression.1 The necessity for optimal topical acne treatment stems from the need to manage and mitigate these impacts effectively. Optimal topical acne treatments should ideally target multiple pathways involved in acne development.2 Traditional treatments, though often effective, may come with limitations such as skin irritation, dryness, or other adverse effects. Thus, the pursuit of optimal topical acne treatments is critical to enhancing efficacy, minimizing side effects, and improving patient adherence and satisfaction.
Lack of drug efficacy, low tolerability, and regimen complexity historically lead to poor treatment adherence and suboptimal outcomes.3 Innovation in vehicle composition and drug delivery technologies have helped improve all metrics resulting in increased patient satisfaction and reduced overall costs.4 For instance, benzoyl peroxide and retinoids remain cornerstone treatments, but their formulations have evolved to enhance tolerability. Micronized formulations, encapsulation technologies, and combination therapies are examples of innovations aimed at optimizing these agents’ efficacy and reducing their irritating potential.5
Antibiotic stewardship in acne management is crucial to combating the rising threat of antibiotic resistance.6 The widespread use of antibiotics, particularly topical clindamycin and erythromycin, has led to increased resistance among Cutibacterium acnes (C. acnes) and other bacteria. This resistance diminishes the efficacy of treatments and can complicate acne management. Effective stewardship involves using antibiotics judiciously, primarily reserving them for moderate to severe cases where other treatments have failed. Combination therapies, such as pairing antibiotics with benzoyl peroxide (BPO), are recommended to reduce resistance risk by leveraging its bactericidal properties. Limiting antibiotic use duration and transitioning to maintenance therapies with retinoids or BPO alone further helps mitigate resistance. Additionally, the development and use of non-antibiotic therapies play a vital role in reducing antibiotic reliance. By adhering to these principles, practitioners can help preserve antibiotic efficacy.
