Even if acne represents one of the most spread diseases, we still known very little on its cause, pathogenesis and therapy. With the support of pharmaceutical industry, the members of Global Alliance to Improve Outcomes in Acne have updated their recommendations, dating back to 2003, on the management of this disease, updating it with new medical and surgical therapies. The concept of acne deriving from it is that of a chronic disease with spontaneous remissions implying permanent psychological and physical scars. That’s the reason why an aggressive therapy and a long-term maintenance are proposed. Four primary factors, determining the onset of the disease, are presented: sebum production, bacterial colonization of follicles by Propionibacterium acnes, the alteration of keratinization and the release of inflammatory substances at the skin level. Each of these processes seems more complex than it was thought (for example, sebaceous glands regulate endocrine function and directly and indirectly influence the skin anti-bacterial defenses). Both according to evidence and following experts’ advice, recommendations on treatment include the invitation not to use an antibiotic monotherapy because of bacterial resistances, but to exploit also antibiotic anti-inflammatory action. Topical retinoids are above all useful during maintenance, given their anticomedonic and anti-inflammatory action. Benzoyl peroxide, even being not an antibiotic, has anti-bacterial and keratolitic properties, so treatment must be a combination of antibiotics, benzoyl peroxide, retinoids and azelaic acid. Recommendations do not imply any consideration about isotretinoin.
The document is up to date and sharable, even if incomplete, and it ranges from medical to surgical therapies. Unfortunately, acne, which is a big problem for many young people, is still today without a definitive eradicating therapy, but treatment must be based on multiple approaches, identified case by case.
