Advances in Acne Management: From Empiricism to Evidence-Based Care

Abstract

Acne vulgaris is a chronic inflammatory disorder with significant psychosocial impact. Its prevalence and prolonged disease course make it an ideal condition for examining the historical evolution of dermatology from empiricism to evidence-based, mechanism-driven care. Early explanations of acne were grounded in pre-scientific medical paradigms, in which the classical humoral theory attributed cutaneous disease to internal imbalance, diet, hygiene, and environmental impurities. The mid-twentieth century was marked by advances in microbiology and pharmacology, facilitating the development of targeted therapies, including antibiotics, retinoids, and isotretinoin, thereby transforming acne treatment into pathophysiology-driven care. By the late twentieth century, the role of hormonal regulation became increasingly apparent, with androgens being recognised as key drivers of acne pathogenesis. Concurrently, growing recognition of the psychological burden of acne contributed to the emergence of psychodermatology. Modern acne management is characterised by an evidence-based, multimodal approach that reflects the disease’s multifactorial pathogenesis, with combination therapy now considered standard of care. Emerging therapies and digital innovations highlight an ongoing shift towards precision and sustainability.