Beyond benzoyl peroxide and antibiotics, what's new in acne?

• A (Dermatologist): Topical retinoids remain first-line, but adherence is poor due to irritation. New formulations (microsphere, encapsulated) and lower concentrations (0.025% tretinoin) improve tolerability. Also, topical clascoterone (Winlevi)—the first new mechanism in 40 years—blocks androgen receptors in the skin.

• B (Researcher): The microbiome is the frontier. Cutibacterium acnes phages—viruses that specifically kill acne-causing strains while leaving beneficial strains—are in Phase 2 trials. Also, topical niacinamide and zinc reduce inflammation without antibiotics.

• C (Pharmacist): Oral antibiotics (doxycycline, minocycline) are overprescribed. Long-term use drives resistance and destroys gut health. We need more prescribing of topical alternatives and spironolactone for adult female acne.

• D (Patient): I've tried everything for my hormonal acne—birth control, Spiro, topical creams. Accutane (isotretinoin) worked but the side effects (dry eyes, joint pain, mood changes) were brutal. We need a systemic treatment that isn't so toxic. Also, insurance should cover chemical peels and blue light therapy, which I paid $500 for out of pocket.