Newer Approaches in Topical Combination Therapy for Acne

Lisa W. Fu, BHSc; Ronald B. Vender, MD, FRCPC


Skin Therapy Letter. 2011;16(9) 

In This Article

Abstract and Introduction


Acne vulgaris is a common chronic inflammatory cutaneous disease involving the pilosebaceous unit. Its pathophysiology is multifactorial and complex, including obstruction of the pilosebaceous unit due to increased sebum production, abnormal keratinization, proliferation of Propionibacterium acnes (P. acnes), and inflammation. Topical agents are the most commonly used therapy for acne. First generation topicals mainly consist of single agent retinoids, benzoyl peroxide (BPO) and antibacterials that target comedones, P. acnes, and inflammation. Novel topical therapies include combination products with advanced vehicle formulations that target multiple acne pathophysiologies and offer simplified treatment regimes. For example, the combination of clindamycin and tretinoin in a unique vehicle formulation allows for progressive follicle penetration and decreased irritation, resulting in increased efficacy. Furthermore, adapalene or clindamycin with BPO combinations target comedones, inflammation, and P. acnes synergistically. These newer combination products have the potential to increase both efficacy and patient adherence when compared with single agent treatment.


Acne vulgaris is a common chronic inflammatory cutaneous disease involving the pilosebaceous unit. Acne is a common worldwide skin disease that affects about 85% of individuals between the ages of 12–24 years.[1] The pathophysiology includes androgen-mediated stimulation of sebaceous gland activity, abnormal keratinization leading to follicular plugging (comedo formation), proliferation of P. acnes within the follicle, and inflammation.[2] Genetic factors, stress, and possibly diet may influence the development of acne.[2] Acne can cause a considerable amount of emotional distress and physical discomfort, thus medical treatment must be accompanied by patient counseling and education, which can contribute to improved self-esteem and adherence to therapy.


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