Emerging Topical Antimicrobial Options for Mild-to-moderate Acne: a Review of the Clinical Evidence

Topical antimicrobial agents are commonly used as first-line agents for the management of mild to moderate acne vulgaris. Agents with antibacterial activity (eg, benzoyl peroxide and clindamycin), reduce counts of Propionibacterium acnes, while also decreasing the numbers of inflammatory and noninflammatory lesions. In order to optimize efficacy, topical antibiotics are most commonly used in combination with benzoyl peroxide, an approach which also reduces the emergence of strains of P acnes that are less sensitive to antibiotics. Other topical antiacne options include retinoids (with or without an antimicrobial agent), sulfacetamide, sulfacetamide-sulfur, and azelaic acid. Certain formulations of benzoyl peroxide offer improved tolerability, while a new micronized form may enhance efficacy by optimizing follicular penetration. This wide array of options allows dermatologists to tailor topical treatments to the needs of individual patients.