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  • Presentation

Advances in Acne and Rosacea Treatments, Safety, and Guidelines

Description

The talk reviewed recent advances and practical issues in acne and rosacea care. For acne, the speaker highlighted the growing burden in adults ages 18 to 44 and the psychosocial impact, including higher antidepressant use with increasing age and with systemic plus topical therapy. Home light devices using blue and red wavelengths were discussed, with combined light appearing most effective, but evidence remains limited, prices vary widely, and only a few devices are FDA cleared. An open-label study of an FDA-cleared device showed improved inflammatory and noninflammatory lesions and quality of life with good tolerability. An antioxidant silymarin serum was presented as a skincare-oriented adjunct that improved hyperpigmentation, lesion counts, and skin appearance, though caution was advised in patients prone to contact dermatitis. Levonorgestrel IUDs were associated with increased acne risk compared with copper IUDs, with some brand differences. Benzene concerns around benzoyl peroxide were addressed by emphasizing degradation with heat rather than contamination, no increased blood benzene levels in users, and practical advice to follow manufacturer storage instructions, discard products after about 10 to 12 weeks, and avoid using products exposed to high heat. Updated 2024 acne guidelines strongly recommend topical antibiotics, benzoyl peroxide, retinoids, doxycycline for severe acne, and isotretinoin for cystic/scarring disease, while clascoterone and sarecycline received conditional recommendations mainly due to cost. Antibiotic stewardship was stressed, including uncertainty about optimal duration and cautions with trimethoprim-sulfamethoxazole. For rosacea, data were presented on microencapsulated benzoyl peroxide cream, low-dose minocycline with strong efficacy and good safety, and emerging options such as JAK inhibitors, Spongilla, Nitrosomonas eutrophia, lotilaner for Demodex, and topical roflumilast.

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Conclusions

  • Modern acne care is shifting toward the growing adult acne population, especially patients aged 18 to 44, who often have both treatment and skincare concerns.
  • Acne is associated with meaningful psychosocial burden, including higher antidepressant initiation in real-world data.
  • At-home LED masks may help acne, but the market is highly variable in specifications, safety data are limited, and there are no randomized trials proving one device is best.
  • An FDA-cleared red-blue LED device showed improvements in lesion counts, acne quality of life, and tolerability in adolescents and adults using home phototherapy.
  • Antioxidant skin care, such as silymarin serum, may improve acne and post-inflammatory hyperpigmentation by reducing oxidative stress and lipid oxidation.
  • Patients with sensitive skin or contact dermatitis may not be good candidates for silymarin because of its botanical source.
  • Levonorgestrel IUDs appear to be associated with more acne than copper IUDs, and acne risk may differ by IUD brand and dose.
  • Benzoyl peroxide can degrade into benzene under certain conditions, but available human data do not show increased blood benzene levels with use.
  • Proper benzoyl peroxide storage matters, and products exposed to heat or kept too long should be discarded according to guidance.
  • The 2024 acne guidelines continue to favor topical retinoids, benzoyl peroxide, and topical antibiotics for mild to moderate acne, with doxycycline and isotretinoin reserved for more severe disease.
  • Antibiotic stewardship remains important in acne because comparative data among tetracyclines are limited and optimal treatment duration is still uncertain.
  • Sarecycline may offer advantages because it is narrow spectrum and may reduce microbiome disruption and resistance pressure.
  • Trimethoprim-sulfamethoxazole should be used cautiously in acne because of safety concerns, including reported respiratory failure risk in young patients.
  • Microencapsulated benzoyl peroxide can improve papulopustular rosacea and is generally well tolerated, including in older patients.
  • Low-dose minocycline for rosacea outperformed doxycycline and placebo in phase 3 trials while remaining well tolerated.
  • Emerging rosacea therapies, including JAK inhibitors, may be especially useful for inflammatory or steroid-induced subtypes.
  • Future rosacea treatments may include microbiome-modulating agents, Demodex-targeted therapy, and topical roflumilast, which could broaden options for difficult cases.
  • Antidepressant Initiation Among Patients With Acne: Evidence From a Large Real-World Cohort.#10.1111/ijd.70270
  • Phototherapy with blue (415 nm) and red (660 nm) light in the treatment of acne vulgaris.
  • Heterogeneity in Specifications of At-Home Red and Blue LED Masks for Acne Treatment in the U.S. Market.
  • A 7-Week, Open-Label Study Evaluating the Efficacy and Safety of 415-nm/633-nm Phototherapy for Treating Mild-to-Moderate Acne in Adolescents and Adults.
  • A Silymarin Antioxidant Serum Improves Facial Acne Alone and as Part of a Treatment Regimen.#10.36849/jdd.8120
  • Frequency of androgenic cutaneous adverse events associated with levonorgestrel intrauterine devices: An analysis of the Food and Drug Administration Adverse Event Reporting System database.#10.1016/j.jaad.2024.10.045
  • No evidence for an association between benzoyl peroxide use and increased blood benzene levels in the National Health and Nutrition Examination Survey.#10.1016/j.jaad.2026.05.119
  • Guidelines of care for the management of acne vulgaris.
  • Optimal Use Recommendations and Stewardship Principles with Oral Antibiotics in Acne Vulgaris Management: An Expert Consensus Panel.
  • Trimethoprim-Sulfamethoxazole and Acute Respiratory Failure in Adolescents and Young Adults.#10.1001/jamanetworkopen.2025.45251
  • Efficacy and Safety of Microencapsulated Benzoyl Peroxide Cream, 5%, in Papulopustular Rosacea in Elderly Patients: Post-hoc Analysis of Results from Two Randomized, Phase III, Vehicle-controlled Trials.
  • Efficacy, Safety, and Tolerability of Oral DFD-29, Low-Dose Formulation of Minocycline, in Rosacea: Two Phase 3 Randomized Clinical Trials.
  • Oral JAK Inhibitors as a Promising Therapeutic Strategy for Refractory Rosacea: A Systematic Review and Meta-Analysis.
  • Clinical study of JAK inhibitors in the treatment of rosacea with erythematotelangiectatic rosacea.
  • A controlled clinical study and safety assessment of abrocitinib in the treatment of erytherotelangiectasia rosacea.
  • DMT310-005, Topical in the Treatment of Acne Rosacea.#10.1007/978-3-540-69375-8_92
  • A Study to Determine Safety and Efficacy of B244 in Subjects With Mild to Moderate Rosacea.
  • Study of TP-04 in Participants With Papulopustular Rosacea.
  • Evaluation of the Safety and Efficacy of Topical Roflumilast Cream in the Treatment of Facial Papulopustular Rosacea.