Therapy of acne.

Today acne vulgaris is a disease which can be well controlled using a combination of topical, systemic, and physical therapeutic modalities. However, successful acne management depends to a large extent on physician interest and the ability of the physician to apply therapy to the evolutionary stage of the disease and to the disturbed pathogenetic mechanisms. It is this author's opinion that grades I and II comedonal and papulopustular acne can be effectively treated solely with topical preparations, particularly the concurrent use of tretinoin with benzoyl peroxide or topical antibiotics. The majority of patients with grades III and IV inflammatory disease require oral antibiotics in addition to aggressive topical treatments. Intralesional steroids can be effective in all grades of acne when lesions develop an inflammatory nodulocystic quality. The physician should consider the use of estrogen (in females) or oral vitamin A in the small group of patients with grades III and IV inflammatory-cystic acne that has been unresponsive to conventional therapy. Combined systemic therapies of high-dose antibiotics, systemic corticosteroids, and sulfones clearly take precedence over topical preparations in conglobate acne and acne fulminans. Finally, oral isotretinoin, alone and perhaps in combination with more conventional modalities, should play an important role in the future management of severe inflammatory-cystic acne.