- Severe juvenile acne risks permanent scarring and psychological harm; early specialist assessment and timely intervention are essential to prevent long term sequelae.
- Oral isotretinoin remains the gold standard for nodulocystic, scarring or treatment resistant acne, used in accordance with product information, regulation and risk minimisation.
- Antibiotic exposure should be minimised through stewardship, combining benzoyl peroxide, shortening courses and adopting individualised, microbiome conscious, inflammation targeted strategies to prevent scarring.
Expert Opin Pharmacother. 2026 Aug 5. doi: 10.1080/14656566.2026.2715706. Online ahead of print.
ABSTRACT
INTRODUCTION: Severe juvenile acne vulgaris represents a highly prevalent chronic inflammatory disorder that may significantly impair quality of life and lead to permanent scarring during adolescence. Increasing understanding of acne pathophysiology has progressively modified therapeutic approaches, with growing emphasis on early intervention, antimicrobial stewardship, and individualized systemic treatment strategies.
AREAS COVERED: This narrative review summarizes current evidence regarding pharmacotherapeutic strategies for severe juvenile acne, with particular focus on systemic therapies. A literature search was conducted in PubMed, Embase, Google Scholar, Cochrane Library, and ClinicalTrials.gov from database inception to March 2026. The pathogenic mechanisms underlying juvenile acne, including sebaceous hyperactivity, follicular hyperkeratinization, Cutibacterium acnes, dysbiosis, immune-inflammatory activation, and hormonal influences, are discussed.
EXPERT OPINION: Severe juvenile acne should not be underestimated as a physiologic condition of adolescence, as delayed or inadequate treatment may result in substantial physical and psychological sequelae. Oral isotretinoin remains the gold-standard therapy for severe nodulocystic, scarring, or treatment-resistant acne. Timely specialist assessment is essential in high-risk adolescents to avoid unnecessary delay when the licensed criteria for isotretinoin treatment are fulfilled; however, its use must remain consistent with applicable product information, regulatory requirements, and risk-minimization measures. Simultaneously, prolonged systemic antibiotic exposure should be minimized through stewardship-oriented approaches integrating benzoyl peroxide combinations and shorter treatment durations. Future therapeutic strategies will likely move toward increasingly individualized, microbiome-conscious, and inflammation-targeted approaches aimed not only at lesion clearance but also at prevention of long-term scarring and psychosocial burden.
PMID:42555374 | DOI:10.1080/14656566.2026.2715706
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