Multifactorial approach in the treatment of acne vulgaris: an integrative review.

Abstract

Abstract: Acne vulgaris is a chronic inflammatory skin condition highly prevalent among adolescents, affecting nearly 100% of the population in some studies. It manifests as closed comedones (pimples) and open comedones (blackheads) due to follicular distension and the oxidation of sebum lipids. These non-inflammatory lesions cause physical discomfort and negatively impact quality of life. Therefore, the Brazilian Society of Dermatology recommends treatment to prevent scarring and preserve skin health. Due to its multifactorial nature, management requires a combined approach, including topical therapies (salicylic acid, benzoyl peroxide, and antibiotics), oral contraceptives for women with a hormonal component, and oral isotretinoin for refractory cases. The objective of this integrative review was to compile therapies published within the last ten years. Of the 645 studies identified from 2013 to 2023, 14 were selected based on availability and relevance using the search terms "acne vulgaris," "treatment," "inflammation," and "Cutibacterium acnes." Notable innovations include clascoterone (a topical androgen receptor antagonist), sulforaphane, and lactoferrin. Other innovations include low-power laser therapy, microemulsions containing azelaic acid and tea tree oil, and dendrimeric isotretinoin formulations. The review also addresses complementary therapies, such as herbal medicines, vitamins, and supplements, as well as the relationship between diet and acne. The protocols, safety, efficacy, and limitations of the studies are discussed, emphasizing the need for robust clinical trials and standardized guidelines. Future prospects include molecular target therapies, controlled-release formulations, and integrated strategies for dermatological, nutritional, and psychological care.