ROLE OF NEW ANTIACNE AGENTS IN TREATMENT STRATEGIES
The new topical retinoids are at least equal in efficacy compared with existing topical retinoid preparations.
More importantly, these agents may offer an advantage over existing topical retinoids in decreasing local irritation. Local irritation is the most common adverse effect associated with existing topical retinoids and can result in discontinue action of therapy or other compliance problems. The newer agents may therefore improve compliance and, consequently, success of therapy. They are most appropriate for patients with mild to moderate comedonal and mixed inflammatory acne. Clinical experience may help dictate the proper choice among them for specific patients.
Because they are one of the few treatment modalities that affect the hormonal aspect of acne pathogenesis, and, indirectly, sebum production, oral contraceptives are appropriate treatment options for female patients with moderate acne and no contraindications to hormonal therapy.  They may be particularly useful for patients who also desire contraception or whose acne is secondary to a hyperandrogenic disorder. Based on the results of comparative clinical trials and its favorable safety profile, azelaic acid may be an appropriate first-line treatment for mild to moderate acne.  Finally, because azelaic acid has no known interactions with other topical anti-acne agents, it can be effectively used in combination therapy.
This property gives physician's greater flexibility when developing individual treatment regimens. The new formulation of sodium sulfacetamide (Klaron Lotion) is also an appropriate first line treatment for mild to moderate inflammatory acne in patients with no known hypersensitivity. It can also be safely used in combination therapy with BPO, retinoids, oral antibiotics, or hormonal therapies, particularly in patients with sensitive skin.
AREAS OF NEED IN ACNE MANAGEMENT
In all situations, the primary goal of acne treatment is maximization of efficacy with the minimization of the risk of adverse effects. In the management of acne, a variety of established therapies with different mechanisms of action are available to accomplish this goal. However, successful treatment with these agents is sometimes limited by tolerability or resistance problems. For example, topical tretinoin is often associated with local irritation that can present a compliance problem for some patients. Benzoyl peroxideis also a local irritant and can bleach clothing.
Clinically, dermatologists have been aware of the development of antibiotic resistance in patients whose initial favorable response waned over time. Traditionally, antibiotics were periodically switched in an effort to regain control over the patient's acne. Additional epidemiologic studies are needed to track patterns of Acne resistance to antibiotics. Data gained from such studies will aid in the development of guidelines for designing therapeutic regimens that can minimize the development of resistance.
SUMMARY
Successful management of acne requires careful pairing of individual patients with the appropriate anti-acne agent and individualized treatment regimens, along with appropriate patient education. A thorough patient evaluation takes into account acne severity and predominant lesion type as well as age, skin type, lifestyle, motivation, and the presence of coexisting conditions. Incorporation of these factors into the choice of a specific treatment program can enhance patient compliance and satisfaction, which is essential for the success of treatment. The recent introduction of several new agents affords greater flexibility in the treatment of acne. The availability of these new options to complement the existing ones should greatly facilitate the successful treatment of greater numbers of patients with acne within proved tolerability and patient satisfaction.