Although acne is not physically disabling, its psychological impact can be striking, contributing to lower self-esteem, depression, and anxiety [1-3]. As a result, there is a significant demand for effective acne therapies. In 2001, the global market for prescription acne products was estimated to be two billion dollars; the non-prescription market was estimated at two to four times that size .
A variety of medications are available for the treatment of acne. The lack of standardization for grading acne severity and measuring treatment outcomes has made systematic interpretation of the literature difficult . However, quality evidence-based literature in the field of acne is growing [6,7].
The clinical findings and therapeutic principles that support the selection of specific treatment regimens will be discussed here. A table summarizing the treatment recommendations for patients with acne vulgaris is provided (algorithm 1).
In addition, the anti-acne products will be reviewed, including topical retinoids, topical antimicrobials, azelaic acid, oral antibiotics, and hormonal therapies (table 1). Adjunctive therapies and over-the-counter regimens, oral isotretinoin, hormonal therapies, and the pathogenesis and diagnosis of acne vulgaris are reviewed separately. (See "Light-based, adjunctive, and other therapies for acne vulgaris" and "Oral isotretinoin therapy for acne vulgaris" and "Hormonal therapy for women with acne vulgaris" and "Pathogenesis, clinical manifestations, and diagnosis of acne vulgaris".)
The treatment of acne includes a number of topical and systemic therapies and is guided by several clinical features (table 1) . Deciding on the appropriate course of treatment for an individual patient requires a comprehensive assessment that includes: