Laxmi Iyengar, Belinda Welsh
Acne vulgaris is a chronic inflammatory condition with a substantial psychosocial burden. Early effective therapy reduces the risk of permanent scarring and mental health impacts. Combination topical therapy is recommended as initial and maintenance treatment for most patients (e.g. benzoyl peroxide and a topical retinoid). Topical antibiotics should not be used long-term, or as monotherapy, because of the risk of antibiotic resistance. Management has shifted away from prolonged oral antibiotic courses. If oral antibiotics are used, they should be time-limited (generally no more than 3 months) and paired with a non-antibiotic topical therapy. Oral isotretinoin is the most effective option for severe, scarring or treatment-resistant acne. Recent safety updates emphasise baseline and ongoing assessment of mental health, counselling about possible sexual adverse effects and stringent pregnancy prevention. The combined oral contraceptive and spironolactone are effective systemic options for women with persistent acne that can reduce reliance on repeated or prolonged antibiotic courses. Light-based therapies and physical therapies (e.g. comedone extraction) can be useful adjuncts, ideally accessed through dermatologists.