The evolution of acne therapy

From antiseptics and retinoids to prebiotics and probiotics

2026-01-14

Acne treatment has long relied on antiseptic approaches. New data on the skin microbiome demonstrate that reductionist strategies may be ineffective or even harmful in the long term. This has given rise to the modern trend of microbiome-friendly therapies.

Classical protocols involved cleansing and reducing the number of P. acnes using benzoyl peroxide, acids or antiseptics. These methods eliminate not only pathogenic, but also beneficial bacteria, which led to a short-term effect and rapid relapses.

The second stage of therapy development is the use of retinoids, which reduce the activity of 5-α-reductase and sebum synthesis. This indirectly worsens the conditions for P. acnes. However, retinoids disrupt the barrier, provoke irritation and do not provide stable remission.

The modern approach is to restore the skin microbiome. Beneficial bacteria are able to suppress excessive reproduction of microbial strains, displace pathogens, synthesize anti-inflammatory molecules and reduce the activity of both 5-α-reductase and other inflammatory factors. Prebiotics and probiotics are used for this.

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