Acne Vulgaris

Mild acne consisting of open and closed comedones with a few ILs is commonly treated with topical agents. Several options are effective in placebo-controlled randomized controlled trials (RCTs), and all can be used either alone or in combination. Options include the topical retinoids, benzoyl peroxide, salicylic acid, and azelaic acid. All of the agents reviewed in the chapter are effective in the treatment of mild and moderate acne vulgaris. Oral antibiotics were used initially in the 1950s because it was assumed that acne occurred as a result of bacterial infection. Whilst activity against P. acnes has been clearly demonstrated, there is evidence of an anti-inflammatory effect. A number of RCTs have investigated oral and topical antibiotics either against or in combination with other agents. Oral isotretinoin has been shown to decrease sebum excretion, keratinization, inflammation, and follicular colonization by P. acnes and other organisms, such as Pityrosporum spp.