In this session, James Del Rosso, DO, and Karan Lal, DO, provided insights into management of patients with acne. 

The presentation started with emphasis on patient-centered and collaborative care that sets the stage for successful acne treatment, emphasizing patient education, collaborative review of treatment options, joint-decision making, and compliance and follow-up. The presentation highlighted the need for combination therapy to address the 4 major factors involved in acne pathogenesis (ie, excess sebum production, follicular hyperkeratinization, cutibacterium acnes colonization and proliferation, and inflammation). Clascoterone is a competitive antagonist to the DHT-receptor that can reduce the effect of downstream androgen effects in skin for both genders above 12 years old. It has been shown to be effective and tolerable when used as a monotherapy but is recommended as an additional treatment in a combination regimen. 

Beyond the tried-and-true monotherapies that can be combined in a multistep regimen, there are double- and triple-combination topical acne products that include benzoyl peroxide (BPO), retinoids, and antibiotics to reduce treatment regimen steps. Clindamycin 1.2% + BPO + adapalene 0.15% gel has been shown to be effective in moderate-to-severe inflammatory and noninflammatory acne. 

They discuss further the various nuances in the art of acne treatment. When comparing topical antibiotic treatments, clindamycin showed longer-term efficacy and anti-inflammatory properties than erythromycin. Just as the type of antibiotic chosen can make a difference, delivery can also change efficacy. It was emphasized that the formulation of products and vehicles matter—polymeric emulsion formulation has been shown to better stabilize and deliver active ingredients while increasing tolerability. 

Rosso and Lal conclude with an interactive discussion and case presentations that present a stepwise approach to patients with acne. Cases start with the patient-centered approach mentioned above and critical thinking about compliance, motivation, tolerability, and severity of lesions. They then recommend selecting from a wide range of topical regimens first while keeping those patient-specific factors and goals in mind.