Acne is a common skin disorder affecting 10 % of the global population making it the 8th most prevalent disease worldwide. It has been estimated that >80 % of people between the ages 12 and 24 experience at least minor acne. While it most often affects teenagers, for some it is a chronic disease continuing in the adulthood.

Acne is a multi-factorial disease, in which androgen-driven excess sebum production is one of the contributing factors. Acne affects pilosebaceous units in the skin and develops when pores are blocked, inflamed and swollen. The pathogenesis of acne involves four main pathways, all of which are targets of medical intervention.

Hormonal therapies are under-represented treatment option in acne due to anti-androgenic side effects of oral anti-androgens restricting their use to female patients. The therapeutic effect of anti-androgen is non-debatable, which is underlined by the use of combined oral contraceptive pills in the treatment of acne and off-label use of oral anti-androgens. Topical anti-androgen will be a much needed novel treatment option for acne. 

Acne is a multi-factorial disease

The four main pathways in the pathogenesis of acne and their medical interventions. Androgen-driven excess sebum production can be counteracted by anti-androgens. Vitamin A derivatives, retinoids normalize skin shedding and thus inhibit obstruction of pores. Antibiotics and antiseptics, like benzoyl peroxide kill bacteria and reduce inflammation.