Rationale for the development of new topical treatments for acne vulgaris.

The development of new topical anti-acne therapies reflects the need for medications that address the requirements and concerns of an increasingly mature and demanding acne patient population. Some of the topical agents currently under investigation in the United States include several alpha-hydroxy acids (AHAs), the retinoids tazarotene and adapalene, and azelaic acid. All of these agents appear to exert their effect on acne through some effect on the process of keratinization and/or the thickness of the stratum corneum. Azelaic acid also has significant antimicrobial activity relevant to its efficacy in acne vulgaris. While azelaic acid has already been used successfully in many parts of the world for several years, the potential roles of the new retinoids in acne therapy are just beginning to be clarified. The properties of AHAs suggest that they may also be of value in the treatment of acne, but further systematic evaluation is needed.