Advances in Acne Vulgaris: From Pathogenesis to Innovative Drug Delivery.

INTRODUCTION: Acne vulgaris (AV) is a common chronic inflammatory disorder of the pilosebaceous unit that affects adolescents and adults globally. Despite the availability of multiple therapeutic approaches, limitations such as poor patient adherence, adverse effects, and antibiotic resistance necessitate improved treatment strategies. This review explores recent advances in acne pathogenesis and innovative drug delivery systems to improve therapeutic outcomes. METHODS: This narrative review is based on a comprehensive analysis of published literature. Relevant data were collected from peer-reviewed journals, scientific databases, and recent publications focusing on acne pathophysiology and advanced drug delivery approaches. No ethical approval was required as the study involved a secondary data analysis of published literature. RESULTS: Acne pathogenesis is multifactorial, involving increased sebum production, Cutibacterium acnes proliferation, follicular hyperkeratinization, inflammation, and emerging epigenetic factors, such as DNA methylation. Conventional therapies, including topical retinoids, antimicrobials, systemic antibiotics, and hormonal treatments, remain standard but have limitations. Novel drug delivery systems, such as microsponges, vesicular carriers (liposomes, niosomes, transfersomes, and bilosomes), lipid-based nanocarriers (solid lipid nanoparticles, nanostructured lipid carriers, and nanoemulsions), and polymeric/dendrimeric systems, have demonstrated improved follicular targeting, controlled drug release, enhanced stability, and reduced skin irritation. DISCUSSION: Integrating advanced drug delivery systems addresses key challenges in conventional therapies by improving drug bioavailability, minimising systemic exposure, and enhancing patient compliance. Targeting emerging pathogenic mechanisms, including epigenetic modulation, may further optimise acne management strategies. CONCLUSION: Acne vulgaris poses a significant clinical and socioeconomic burden. Innovative drug delivery systems offer promising solutions to overcome the limitations of traditional therapies. However, further clinical validation, long-term safety studies, and regulatory alignment are essential for successful translation into routine clinical practice.