Topical treatment of acne vulgaris: A review

Depending on the dominant lesion and on the clinical frame, acne is classified as mild (comedonal and papular/pustular with few elements), moderate (papular/pustular with several elements and nodular) and severe (severe nodular or conglobata). In the mild/moderate forms, topical agents can be used singularly or in combination, while, in the most severe forms, they are used in association with systemic therapy. Among the topical agents, the most important are antiseptics (benzoylperoxide, hydrogenperoxide, azelaic acid), antibiotics (clindamycin, erythromycin), retinoids (tretinoin, adapalene, isotretinoin, tazarotene and motretinide) and retinaldehyde and retinoyl-β-glucuronide, and others like, formulations of sulfur, resorcinol, salicylic acid and corticosteroids. In the therapeutic approach to acne, the topic formulations are chosen depending on the skin type, following some basic rules. In general, formulations in gel and solutions are used on oilier skin, gel and cream formulations on normal skin, creams and lotions on dry and sensitive skin. The topical formulations should be applied to the entire acne-prone area and not only on the active lesions. During the first weeks of treatments, a transitory worsening may occur. It is very important to educate the patient in order to continue further the treatment, sometimes up to 8 weeks before significant results can be seen. Topical agents act in different ways on 3 mechanisms of acne pathophysiology (ductal hypercornification, P. acnes proliferation, and inflammation) but not on sebum production.