Understanding the Current Acne Armamentarium

This case-based peer discussion begins with a review of acne pathogenesis and the mechanisms of topical therapy, focusing on retinoids, benzoyl peroxide, and antiandrogen agents such as clascoterone. Hilary Baldwin, MD, outlines how modern topical regimens target multiple pathways—comedogenesis, inflammation, bacterial overgrowth, and sebum production—while maintaining patient comfort. The opening section emphasizes the need to educate patients about irritation, dryness, and consistency, which are pivotal for success, especially in younger demographics who often struggle with adherence.

In the first case, a 15-year-old girl with moderate comedonal acne receives a stepwise regimen including tretinoin and benzoyl peroxide, which is later supplemented with clascoterone for hormonal control. Discussion centers on patient education, parental support, and the psychological impact of acne during adolescence. The second case explores acne in a 17-year-old competitive swimmer, whose treatment incorporates clascoterone, doxycycline, and, later, a retinoid (tazarotene), emphasizing sequencing, tolerability, and minimizing irritation. Through these examples, Baldwin highlights how personalization, product layering, and proactive communication promote both adherence and satisfaction.

The final case presents a 26-year-old woman with acne and postinflammatory hyperpigmentation (PIH), underscoring the importance of addressing both medical and cosmetic concerns, particularly in patients of color. A fixed-dose topical combination and education about PIH and sun protection are key to long-term improvement. The discussion concludes by reinforcing the value of thorough patient histories, realistic goal-setting, and gradual regimen adjustments. Across all cases, Baldwin demonstrates how individualized, mechanism-based approaches and empathetic patient engagement can lead to durable acne control and improved quality of life.