Current and Emerging Drug Therapy for Acne Vulgaris: A Comprehensive Review

Acne vulgaris is a highly prevalent chronic inflammatory disorder of the pilosebaceous unit that affects the majority of adolescents and young adults. Its pathogenesis is multifactorial and is driven largely by hormonal dysregulation, which promotes excess sebum production and follicular hyperkeratinisation, resulting in pore occlusion and the characteristic inflammatory lesions accompanied by swelling and erythema. Acne is caused by Cutibacterium acnes, which colonizes and activates acquired and innate immune responses. Acne is also produced owing to stimulation of the IGF-1 factor, disturbance of the omega-3 and omega-6 cycles, suppression of FoxO1, and activation of mTORC1, which assists in boosting sebum production. Proven treatments target these mechanisms by utilizing systemic and topical drug-delivery systems. Topical retinoids, which have antiinflammatory and anti-acne properties, such as azelaic acid, benzoyl peroxide, salicylic acid, dapsone, and topical or oral antibiotics, are used to treat acne. However, these formulations have limitations, including the need for prolonged treatment, persistent skin irritation, and the development of antibiotic resistance. To overcome these limitations, novel approaches have been utilized, including AI, nano-based formulations, nanoemulsions, semi-synthetic formulations, and herbal formulations. Recent improvements in acne therapy have focused on enhancing effectiveness and safety. The goal of recent developments in acne therapy is to improve treatment efficacy and safety. New drug delivery systems incorporating nanotechnology improve targeting of damaged areas and reduce side effects.