Acne Vulgaris Resistant to Conventional Treatment: Current Evidence on Systemic Therapies and Management Strategies
DOI:
https://doi.org/10.5281/zenodo.23303408Keywords:
Acne vulgaris, Treatment resistance, Isotretinoin, Systemic therapy, Antimicrobial resistanceAbstract
Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit that may persist despite conventional treatment, increasing the risk of scarring and psychosocial consequences. This study aimed to review the scientific evidence on the pathophysiology of treatment-resistant acne, the main systemic therapies, and current clinical management strategies. A narrative literature review was conducted, considering clinical studies, scientific reviews, and therapeutic guidelines related to the disease. The analysis addressed the mechanisms involved in lesion development, factors associated with inadequate treatment response, and available pharmacological options. Oral isotretinoin plays a central role in the treatment of severe, scarring, or refractory acne, whereas systemic antibiotics require judicious use because of the risk of antimicrobial resistance. Hormonal therapies represent alternatives for selected patients, according to their clinical characteristics and contraindications. It is concluded that the management of treatment-resistant acne should be individualized, incorporating assessment of treatment adherence, pharmacological safety monitoring, and strategies aimed at preventing scarring, maintaining therapeutic outcomes, and improving quality of life.
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Copyright (c) 2026 Isabella Pelegrini, Samira Fonseca Nogueira Petermann Kyono
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