An overview of acne and its treatment.

The pathophysiology of acne vulgaris results from the interplay of follicular hyperkeratinization, the presence of Propionibacterium acnes bacteria in the follicular canal, and sebum production. Several anti-acne agents are currently available that affect one or more of these pathogenic factors and are effective against one or more acne lesion types. The only currently available agent that is directly effective against comedones is tretinoin. Agents effective against inflammatory lesions include tretinoin, benzoyl peroxide, and topical and systemic antibiotics. Agents effective against nodules and cysts include oral antibiotics and isotretinoin. However, the successful utilization of the available agents and techniques is highly dependent on an accurate and thorough assessment of each patient's needs and concerns, followed by the implementation of an individualized treatment program that has been clearly communicated to the patient. Such a program may employ several different anti-acne agents and adjunctive treatments such as comedo extraction or intralesional injection.