Acne is a chronic inflammatory
skin disease that involves the pathogenesis of four major factors, such as
androgen-induced increased sebum secretion, altered keratinization, colonization of Propionibacterium acnes, and
inflammation. Several
acne mono-treatment and combination treatment regimens are available and prescribed in the Indian market, ranging from
retinoids,
benzoyl peroxide (BPO), anti-infectives, and other miscellaneous agents. Although standard guidelines and recommendations overview the management of mild, moderate, and severe
acne, relevance and positioning of each category of
pharmacotherapy available in Indian market are still unexplained. The present article discusses the available topical and oral
acne therapies and the challenges associated with the overall management of
acne in India and suggestions and recommendations by the Indian dermatologists. The experts opined that among topical
therapies, the combination
therapies are preferred over monotherapy due to associated lower efficacy, poor tolerability, safety issues, adverse effects, and emerging bacterial resistance.
Retinoids are preferred in comedonal
acne and as maintenance
therapy. In case of poor response, combination
therapies BPO-
retinoid or
retinoid-antibacterials in papulopustular
acne and
retinoid-BPO or BPO-antibacterials in pustular-nodular
acne are recommended. Oral agents are generally recommended for severe
acne. Low-dose
retinoids are economical and have better patient acceptance.
Antibiotics should be prescribed till the
inflammation is clinically visible.
Antiandrogen therapy should be given to women with high
androgen levels and are added to regimen to regularize the menstrual cycle. In late-onset
hyperandrogenism, oral
corticosteroids should be used. The experts recommended that an early initiation of
therapy is directly proportional to effective therapeutic outcomes and prevent complications.