Re-evaluating treatment targets in acne vulgaris: adapting to a new understanding of pathophysiology

Two primary factors are changing current approaches to the management of acne vulgaris (AV): the continuously evolving role of Propionibacterium acnes in the pathophysiology of AV and recent evidence of an inflammatory basis for AV via innate immunity. The developing concepts emphasize that acne is primarily an inflammatory disease. The emerging concept of subclinical inflammation and its effect on development and progression of acne lesions correlating with the sequence of the underlying inflammation process has been a major change in our understanding of acne pathogenesis. Thus, inflammation has become the major feature of the disease process from onset to resolution, including postinflammatory erythema, postinflammatory hyperpigmentation, and scarring. Our treatment targets may also need to be reconsidered, with more emphasis on anti-inflammatory treatments.