The New Era of Acne Treatment

Adult acne is more common – and more complex – than many people realise. This in-depth, dermatologist-reviewed guide explains how our understanding of acne has evolved and what that means for treatment today. We explore new science on hormones, the skin microbiome and chronic inflammation, then translate it into clear explanations of modern therapies: advanced topical retinoids, topical androgen blockers like clascoterone, microbiome-friendly pre/probiotic products, narrow-spectrum antibiotics, and low-dose isotretinoin strategies for adults. You’ll learn which options may suit persistent or female-pattern acne, when online care is appropriate, and when in-person review is essential. Finally, we show how doctors365.org makes it easy to book a trusted dermatologist online and start a personalised, evidence-based acne plan from home.

Disclaimer: This article is for educational purposes only. It does not replace a consultation with a doctor, dermatologist or other healthcare professional, and it is not suitable for emergencies.
If you have severe symptoms, feel very unwell, or think you may be experiencing a medical emergency, please contact your local emergency services or attend the nearest emergency department immediately.

Author: Dr. Diellza Rabushaj

Acne is often seen as a “teenage problem”, but many people quickly realise that breakouts don’t always stop at 18. Adult acne – especially in women over 25 – is increasingly common and can be stubborn, painful, and emotionally exhausting.[1–3]

The good news? In the last 10–15 years, science has moved far beyond “wash your face and use benzoyl peroxide”. We now understand much more about the microbiome, hormones, and chronic inflammation in acne, and this has opened the door to new, more targeted treatments.[1]

In this article we’ll break down, in plain language:

• What recent research says about new acne treatments
• How these differ from older options
• When online dermatology (like doctors365.org) is appropriate – and when you really need in-person care
• How to prepare for a high-value online acne consultation

2. What really causes acne?

For many years we’ve talked about four “classic” factors in acne:[2,8]

• Too much sebum (oil)
• Clogging of the hair follicle (hyperkeratinisation)
• Overgrowth of Cutibacterium acnes (formerly Propionibacterium acnes)
• Inflammation in and around the follicle

Those are still true – but newer review articles, especially focusing on adult acne, highlight some important refinements:[1,3]

• Adult acne is often more inflammatory and persistent than teenage acne, with fewer blackheads and more deep, sore bumps.
• Hormonal influences are particularly important in adult women (e.g., jawline and chin flares before periods).[3]
• The skin microbiome (the “ecosystem” of skin bacteria and other microbes) appears to be imbalanced in acne, rather than simply “too much C. acnes”.[1,7]
• Chronic, low-grade inflammation and sometimes an impaired skin barrier seem to keep the process going, even when oil production is not dramatically high.[1,6]

Adult female acne is often persistent (starting in adolescence and never fully stopping) or late-onset (starting after 25), with many patients reporting flares around menstruation and a strong family history.[3] It’s also strongly linked to reduced quality of life, self-esteem issues and higher rates of anxiety or depressive symptoms.[2,3]

3. What’s new in acne science over the last few years?

3.1 Microbiome imbalance

Recent reviews on adult acne emphasise:

• Not all C. acnes strains are “bad” – some may be protective.
• In acne, we see over-representation of certain inflammatory “phylotypes” and changes in the balance between C. acnes, Staphylococcus species and other microbes.[1,7]
• Standard treatments like benzoyl peroxide, antibiotics and isotretinoin change the composition of the microbiome, sometimes in ways that may matter long-term.[7]

This has led to growing interest in microbiome-friendly or microbiome-targeted treatments, such as pre/probiotic topicals and narrow-spectrum antibiotics.[1]

3.2 Hormones and adult female acne

Adult female acne often occurs even in women with “normal” blood tests. However, research shows that:

• Androgens (male-type hormones present in all genders) still drive sebum production and can worsen acne.[3,6]
• Some women have clear hormonal triggers (irregular periods, polycystic ovary syndrome, excess body hair, weight gain), where targeted hormonal therapy is particularly helpful.[3,6]

This understanding underpins both oral hormonal options (e.g., certain combined oral contraceptives, spironolactone) and new topical androgen-receptor blockers (see below).[3,5,6]

3.3 Chronic inflammation & skin barrier

Newer molecular studies suggest that acne involves:

• Persistent activation of innate immunity in the follicle
• Up-regulation of inflammatory pathways (e.g., toll-like receptors, cytokines)
• Sometimes a weakened barrier, increasing irritation and sensitivity[1,5,6]

This is why many modern formulations try to combine active ingredients with soothing, barrier-supporting vehicles to reduce irritation while maintaining efficacy.[1,5]

4. Traditional acne treatments – still the foundation

Even in the newest reviews, the “reference” therapy for acne – including adult acne – is still:[2]

• A topical retinoid (e.g., adapalene, tretinoin)
  plus
• An oral antibiotic for moderate inflammatory disease

And for severe or scarring acne, oral isotretinoin remains the only drug that tackles all major pathogenic factors (sebum, follicular hyperkeratinisation, inflammation and C. acnes).[8]

Adult-focused reviews confirm that these traditional options continue to work well in adults, but highlight:[1,4]

• Adults (especially women) often have more sensitive skin, so irritation from topical retinoids is more frequent.[3]
• Long-term or repeated courses of oral antibiotics raise concerns about antibiotic resistance and microbiome disruption.[1,8]
• For adult female acne, hormonal therapies or low-dose isotretinoin may be better long-term strategies than repeated antibiotic courses.[3,4]

So the focus of “new” treatment is less about replacing these core options and more about using them smarter and adding new, targeted tools.

5. New & emerging topical treatments

5.1 New-generation topical retinoids (e.g., trifarotene)

Trifarotene is a fourth-generation topical retinoid that selectively activates the RAR-γ receptor, the main retinoic acid receptor in the skin.[6] Clinical trial data show it:

• Improves both facial and truncal acne
• Has a retinoid-typical side-effect profile (dryness, irritation) but is generally well tolerated with proper skincare[6]

Its selectivity may allow strong comedolytic and anti-inflammatory action with potentially less systemic exposure.[6]

5.2 Topical androgen-receptor blockers (clascoterone)

Clascoterone 1% cream is the first topical androgen-receptor inhibitor approved specifically for acne in several regions.[5,11]

How it works:

• Competes with androgens at the sebaceous gland receptor, helping to reduce sebum production locally without systemic hormonal effects.[5,11]
• Studies show meaningful reductions in inflammatory lesions and good tolerability when used twice daily.[5,11]

This is particularly attractive for adult female acne and for patients who cannot or prefer not to use oral hormonal therapy, though more long-term data are emerging.[5,6,11]

5.3 Fixed-dose retinoid/antimicrobial combinations

Dréno’s review on adult female acne highlights fixed-dose combinations such as:

• Clindamycin 1% (as phosphate 1.2%)/tretinoin 0.025% gel

These products:[3]

• Target microbial overgrowth and inflammation (via clindamycin)
• Normalise follicular keratinisation (via tretinoin)
• Simplify routines (one product instead of two separate prescriptions)

In one analysis cited by Dréno, inflammatory lesions dropped by around 70% with such a combination, with acceptable tolerability in adults.[3]

5.4 Microbiome-friendly topicals & pre/probiotics

Dagnelie and colleagues highlight recent interest in pre- and probiotics for adult acne, aiming to rebalance the skin microbiome rather than simply kill bacteria.[1]

Emerging approaches include:[7]

• Topical prebiotics – ingredients that feed beneficial bacteria
• Topical probiotics or postbiotics – live microbes or microbial metabolites to promote a healthier microbiome
• Formulations designed to be less disruptive to the microbiome (gentler surfactants, milder preservatives)

Current evidence is still limited, but early studies suggest adjunctive benefit when these are combined with standard therapies.[1,7]

6. Systemic innovations & smarter use of existing drugs

6.1 Narrow-spectrum antibiotics (e.g., sarecycline)

Traditional oral antibiotics (doxycycline, minocycline) affect a wide range of bacteria. Newer agents like sarecycline, a narrow-spectrum tetracycline-class antibiotic, aim to:[5,10]

• Target C. acnes more selectively
• Reduce impact on gut flora
• Still provide anti-inflammatory benefits

Phase 3 trials show significant reductions in both inflammatory and non-inflammatory lesions versus placebo, with a safety profile similar to other tetracyclines.[10]

6.2 Low-dose and intermittent isotretinoin

For adults, especially women, long-term studies and expert opinion suggest that low-dose isotretinoin (e.g. 0.1–0.3 mg/kg/day or fixed 10–20 mg/day) or intermittent regimens can:[3,4]

• Provide good control for persistent moderate acne
• Reduce mucocutaneous side effects compared with full-dose regimens
• Still require strict pregnancy prevention because of strong teratogenicity

Dréno specifically notes low-dose isotretinoin as an important option in adult female acne when standard topical and hormonal therapies are insufficient.[3]

Important: Isotretinoin must always be prescribed and monitored by a qualified doctor, with pregnancy prevention programmes where applicable.

6.3 Hormonal therapy for adult female acne

Adult female acne responds particularly well to hormonal modulation.[3]

Options include:

• Combined oral contraceptives (COCs) with anti-androgenic progestins
• Spironolactone, an oral anti-androgen

Evidence and expert reviews show that these treatments:[3]

• Reduce sebum production and inflammatory lesions
• Are especially helpful for premenstrual flares, jawline/chin acne and women with signs of hyperandrogenism
• Require monitoring for blood pressure, potassium, thromboembolic risk, and are not suitable in pregnancy

6.4 Special populations: pregnancy, lactation, skin of colour

Vera and others stress that literature on adult acne in special populations (pregnancy, skin of colour) remains limited, so management is often based on general acne guidance plus safety data from other fields.[4]

In these situations, individualised specialist advice is essential.

7. Future directions: microbiome, biologics & novel targets

Recent high-level reviews of acne therapeutics discuss several promising areas:[1,5–7,19,30,34]

• Microbiome-targeted therapies
  • Designer probiotics, bacteriophages and postbiotics aimed at selectively suppressing inflammatory C. acnes strains while preserving beneficial microbes.
• Androgen-pathway modulators
  • New topical or systemic androgen-receptor blockers refining the approach opened by clascoterone.
• Biologics and targeted anti-inflammatories
  • Early work looks at blocking key inflammatory cytokines and pathways involved in acne; these are still experimental and not routine care.[2]
• Energy-based devices
  • Laser and light systems (including recently cleared devices for longer-term control of inflammatory lesions) are being studied as adjuncts, especially for patients preferring non-drug options.[2]

At this stage, many of these treatments are only available in clinical trials or specialist centres, and long-term safety and cost-effectiveness data are still evolving.[2]

8. How an online dermatologist on doctors365.org can help

You don’t need to figure out which of these treatments is right for you on your own. A doctors365.org dermatologist can:

• Assess your type of acne (inflammatory vs comedonal, hormonal features, scarring risk)
• Check for signs of underlying conditions (e.g., PCOS in women)
• Build a stepwise plan that might include:
  • Topical retinoids or new combinations
  • Benzoyl peroxide, azelaic acid or other proven topicals
  • Antibiotics (topical or oral) if appropriate
  • Hormonal therapy or isotretinoin where indicated

Here’s how it typically works:

1. Browse specialists – Go to /doctors/dermatology/all/ and filter by language, country, or availability.
2. Pick a time – Choose a slot that fits your schedule (including evenings/weekends where available).
3. Confirm & pay securely – Transparent pricing and secure online payment.
4. Attend your visit – Join via secure video, share photos and discuss your skin history.
5. Get your plan – After the visit, you receive:
   • A written summary of the consultation
   • Prescriptions (where clinically appropriate)
   • Clear instructions on skincare, lifestyle tweaks and follow-up

9. Benefits of online acne care with doctors365.org

Online care won’t replace every in-person visit, but for most people with mild to moderate acne it offers genuine advantages:

• 24/7 access & quicker appointments
  • No waiting months for a dermatology slot; many patients can be seen within days or hours.
• Privacy & comfort
  • Discuss facial, chest or back acne from a place where you feel safe and less self-conscious.
• Less time & cost
  • No travel time, waiting rooms or time off work/school; you only pay for the consultation itself and any medications.
• Follow-up made easy
  • Adjusting doses, checking side effects, or updating photos is far easier online – crucial for isotretinoin, hormonal therapy or complex regimens.[3,4]

10. Quality, safety & trust at doctors365.org

To keep acne care safe and evidence-based, doctors365.org focuses on:

• Verified doctors
  • Only registered, vetted physicians with appropriate licences and dermatology experience.
• Clinical governance
  • Clear prescribing policies for antibiotics, isotretinoin, hormonal therapy and pregnancy precautions, in line with up-to-date acne guidelines.[4,]
• Data protection & encryption
  • Secure video, encrypted records and privacy-by-design platform architecture.
• Continuous education
  • Doctors stay updated on new treatments like trifarotene, clascoterone and microbiome-targeted therapies through ongoing education and guideline updates.[1,5]

11. Our acne-focused specialists (placeholders)

Because I don’t have direct access to the live Doctors365 specialist list, please replace the placeholders below with 3–5 real dermatologists from your directory.

Doctor Roxana Tomescu
Dermatology – online skin consultation

• Helps with acne, rosacea, rashes and other common skin problems.
• Good option if you want a clear plan for prescription creams or tablets.
• Ideal for first-time online dermatology consultations.

Dr. Jose Aguilar MD PhD
Dermatology – general & complex cases

• Senior consultant dermatologist with international training and experience.
• Suitable if you have long-lasting or treatment-resistant acne or mixed skin issues.
• Can guide you when in-person procedures (peels, lasers, etc.) might be needed after online care.

Hajo Bruining
Dermatology – everyday & aesthetic dermatology

• Experienced in medical and cosmetic dermatology.
• Helpful for patients who want to treat acne and also discuss cosmetic/skin-appearance concerns.
• Good fit for teens and adults who have tried multiple over-the-counter products.

Dr Yolanda Carolina Paz Mejia
Dermatology – international experience

• Supports patients with common issues like acne, blemishes and sensitive skin.
• Helpful if you struggle with irritation or dark marks after breakouts.
• Can simplify your routine and adjust treatments to your skin type.

Dr Zaheer Abbas
Board-certified Dermatologist – general & cosmetic dermatology /

• Board-certified dermatologist with over a decade of experience in general and cosmetic dermatology.
• Suitable for people who want to treat acne and also improve overall skin texture and tone.
• Can advise on long-term maintenance plans after your acne improves.

You can showcase these doctors with short bios and direct links to their booking pages (e.g., /doctors/dermatology/dr-example-name/).

12. Online vs in-person: what’s appropriate for acne?

12.1 Usually suitable for online care

Online dermatology is usually appropriate when you have:

• Mild to moderate acne (blackheads, whiteheads, papules, pustules)
• Suspected hormonal acne (premenstrual flares, jawline/chin involvement)
• Concerns about side effects of current treatment
• Need for maintenance planning or optimisation of skincare
• Questions about newer treatments you might be eligible for

12.2 Situations needing in-person or specialist urgent review

Please seek face-to-face or urgent care if you notice:

• Very painful, deep nodules or rapidly worsening, widespread lesions
• Sudden acne-like rash accompanied by fever, joint pains or feeling very unwell
• Suspicion of drug reactions (e.g., extensive redness, blistering, mucosal involvement)
• Sudden severe headache, vision changes or mood changes in someone taking isotretinoin or other systemic drugs
• Acne associated with signs of serious hormonal disease (e.g., sudden deep voice changes, rapid new facial hair, significant weight gain, menstrual periods stopping)

And at any point, if acne or scarring is affecting your mental health (e.g., thoughts of self-harm, severe low mood), you should seek urgent mental health support and inform your doctor immediately.

13. Pricing, availability & follow-up

Exact prices vary by country and doctor, but typical online acne care on doctors365.org includes:

• Single video consultation fee (often less than a private in-person visit)
• Optional follow-up visit pricing clearly shown before booking
• No hidden membership fees unless clearly advertised

Many dermatologists offer:

• Same-day or next-day appointments
• Evening or weekend slots, ideal if you work or study full-time

Follow-up is key in acne. Expect your doctor to:

• Review your progress after 6–12 weeks
• Adjust doses or switch treatments if needed
• Plan maintenance therapy to prevent relapse – especially important in adult acne.[1,3,4]

For more details, see your local pricing page on doctors365.org

14. How to prepare for your online acne consultation

You’ll get much more out of your visit if you prepare a little:

1. Take clear photos

• Front, left and right side of the face
• Include chest/back if affected
• Use natural light, no heavy makeup

2. List your current skincare and medications

• Cleansers, moisturisers, toners, serums
• Prescription creams/ointments
• Any oral medications (including birth control, supplements, herbal remedies)

3. Think about these questions:

• When did your acne start? Teen years or adulthood?
• Does it flare before periods or with stress?
• Any family history of severe acne or PCOS?
• Previous treatments tried – what helped, what irritated your skin?

4. Have your medical history ready

• Other conditions (e.g., asthma, depression, clotting disorders, kidney issues)
• Pregnancy status or plans (essential for isotretinoin and hormonal therapies)

5. Decide your priorities

• Clearing active spots quickly
• Preventing scars
• Minimising side effects / using “gentler” options
• Trying newer treatments (and understanding if they are appropriate for you)

15. FAQs: new acne treatments & online dermatology

1. Are new acne treatments really better than the old ones?

Not always “better”, but often more targeted. Classic treatments like topical retinoids, benzoyl peroxide and isotretinoin remain highly effective.[2,4,8] Newer options (trifarotene, clascoterone, narrow-spectrum antibiotics, microbiome-friendly products) mainly aim to improve tolerability, reduce resistance, or solve specific problems like hormonal acne.[1,3,5–7,10]

2. Can I get trifarotene or clascoterone from an online doctor?

In many regions, these are prescription-only medicines. An online dermatologist can assess whether you’re a good candidate and, if local regulations allow, prescribe them or suggest alternatives when they’re not yet available in your country.[5,6,11,27]

3. Are pre- and probiotics for acne proven to work?

Evidence is promising but still limited. Reviews suggest microbiome-targeted strategies may help as an adjunct to standard treatments rather than a stand-alone cure.[1,5,7] Your doctor can advise whether any specific product is worth trying alongside proven therapies.

4. Is low-dose isotretinoin safer than full-dose?

Low-dose and intermittent isotretinoin regimens can reduce some side effects and are useful for persistent moderate adult acne, but the drug is still teratogenic and requires strict monitoring.[3,4] Your dermatologist will weigh pros and cons based on your history, pregnancy plans and severity.

5. Can I manage all my acne treatment online, or will I need to see someone in person?

Many people with mild to moderate acne can be fully managed online, including prescriptions and follow-up. However, severe, rapidly worsening, or complicated acne – or any worrying systemic symptoms – may require in-person examination, blood tests or procedures. Your online doctor will tell you if this applies to you and can guide you on next steps.[4,8,27,34]

16. Conclusion & next steps

Recent science has transformed our view of acne from a simple “oily skin” problem into a complex, chronic inflammatory condition influenced by hormones, the microbiome and the immune system.[1,5–7,19,30]

At the same time, the treatment toolbox has expanded:

• New topical agents like trifarotene and clascoterone
• Smarter antibiotic use (narrow-spectrum drugs, combination topicals)
• Low-dose isotretinoin strategies for adults
• Early-stage microbiome- and biologic-based therapies

The challenge – and opportunity – is to combine these advances into a personalised, realistic plan that fits your skin, lifestyle and health profile.

Online dermatologists on doctors365.org can help you navigate this, from first-line topical options to advanced therapies, all from home.

👉 Take the next step:
Book a dermatologist specialising in acne at /doctors/dermatology/all/ and start building a science-based, personalised treatment plan today.

👉 Have a teenager with acne too?
You can book for them as well (where local regulations allow) and get coordinated guidance for the whole family via doctors365.org.

17. References (Vancouver style)

1. Dagnelie MA, Poinas A, Dréno B. What is new in adult acne for the last 2 years: focus on acne pathophysiology and treatments. Int J Dermatol. 2022;61(10):1205–1212. doi:10.1111/ijd.16220. PubMed
2. Ascenso A, Cabral Marques H. Acne in the adult. Mini Rev Med Chem. 2009;9(1):1–10. doi:10.2174/138955709787001730. PubMed
3. Dréno B. Treatment of adult female acne: a new challenge. J Eur Acad Dermatol Venereol. 2015;29(Suppl 5):14–19. doi:10.1111/jdv.13188. PubMed
4. Vera N, Patel NU, Cardwell LA, Saleem M, Feldman SR. Chemical pharmacotherapy options for managing adult acne. Expert Opin Pharmacother. 2017;18(3):263–273. doi:10.1080/14656566.2017.1282460. PubMed
5. Kim HJ, et al. Exploring acne treatments: from pathophysiological mechanisms to current and emerging therapies. Int J Mol Sci. 2024;25(10):5302. doi:10.3390/ijms25105302. MDPI
6. Li Y, et al. Acne treatment: research progress and new perspectives. Front Med. 2024;11:1425675. doi:10.3389/fmed.2024.1425675. Frontiers
7. Dessinioti C, et al. The microbiome and acne: perspectives for treatment. Dermatol Ther (Heidelb). 2024;14(2):e01079. doi:10.1007/s13555-023-01079-8. SpringerLink
8. Reynolds RV, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2024;90(4):743–767. doi:10.1016/j.jaad.2023.10.024. JAAD
9. Shergill M, et al. Comparison of the efficacy of clascoterone, trifarotene, and tazarotene in acne treatment: a meta-analysis. J Drugs Dermatol. 2024;23(3):e11116292. PMC
10. Del Rosso JQ, et al. What’s new in topical acne treatment? Practical Dermatology. 2020;17(5):32–38. practicaldermatology.com
11. MacLellan A. New treatments for acne vulgaris over the past decade. Canadian Dermatology Today. 2024;5(4):e5–e10. canadiandermatologytoday.com
12. Sharif SH, et al. Advances in the treatment of acne vulgaris. Br J Acad Sci. 2025;4(2):101–120. bjas.journals.ekb.eg