Australasian Journal of Dermatology

REVIEW ARTICLE OPEN ACCESS

From Monotherapy to Adjunctive Therapies: Application of

Dermocosmetics in Acne Management Across Australia and
New Zealand
Ryan De Cruz1,2 | Rebecca Nguyen3 | Peggy Chen4 | Delphine Kerob5 | Kurt Gebauer6,7 | Anneliese Willems8 |
Philip Tong9,10 | Michael Lee11

1The Royal Melbourne Hospital, Parkville, Victoria, Australia | 2Southern Dermatology, Murrumbeena, Victoria, Australia | 3Monash Health, Eastern
Health, Clayton, Victoria, Australia | 4Peggy Chen Skin Cancer and Mohs Surgery, New Plymouth, New Zealand | 5La Roche-­Posay Laboratoire
Dermatologique, Levallois, France | 6Fremantle Dermatology, Fremantle, Western Australia, Australia | 7 The University of Western Australia, Crawley,
Western Australia, Australia | 8Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia | 9Digital Dermatology Imaging
Program, School of Biomedical Sciences UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia | 10Department of
Dermatology, St Vincent's Hospital, Darlinghurst, Sydney, New South Wales, Australia | 11Laye Dermatology, Bondi Junction, New South Wales, Australia

Correspondence: Ryan De Cruz ([email protected])

Received: 6 February 2024 | Revised: 29 January 2025 | Accepted: 6 February 2025

Funding: This work was supported by L’Oreal.

Keywords: acne management | acne vulgaris | Australia | dermocosmetics | New Zealand

ABSTRACT
Acne vulgaris is a globally prevalent dermatological disease, with its severity ranging from mild to severe. While moderate to
severe acne often requires topical or systemic pharmaceutical therapy, mild to moderate acne may be managed with dermocos-
metics, which are over-­the-­counter skincare agents with active ingredients that target acne pathophysiology. Dermocosmetics
can also be effective as adjunct therapy for the management of more severe acne. For example, they can be used to complement
the mode of action of pharmaceuticals or to mitigate side effects and improve treatment compliance. This review discusses the
roles of commonly available dermocosmetics in the context of both mild and severe acne management protocols.

1   |   Introduction inflammation; (iii) Cutibacterium acnes dysbiosis [11, 12]; and

(iv) aberrant sebaceous gland function [13]. Recent evidence sug-
Acne vulgaris is recognised as one of the most common inflam- gests that acne is caused by defective differentiation of the LRIG1-­
matory skin conditions globally [1] and is the eighth most preva- expressing stem cells (residing in the hair follicle junction zone)
lent disease worldwide, affecting 9.4% of people [2]. Acne is most into microcomedones instead of normally functioning sebaceous
common in teenagers, universally affecting 85% of adolescents glands [14]. This aberrant stem cell differentiation may be caused
[3]; however, adult acne is on the rise with a 10% increase in by abnormal Wnt signalling [15]. The Cutibacterium acnes (C.
women over the past 10 years [3]. Acne can have a profound im- acnes) phylotype present on the skin can also impact acne develop-
pact on the psychosocial wellbeing and quality of life of individ- ment; different C. acnes phylotypes have been shown to secrete ex-
uals, potentially contributing to depression. Furthermore, acne tracellular vesicles containing proteins that differentially alter the
can potentially lead to permanent scarring [1, 4–10]. communication between the skin microbiota and the host [16, 17].

Acne has a complex pathophysiology, with four main factors: While the selection of acne treatment is often based on the se-
(i) hyperkeratinisation of the pilosebaceous infundibulum; (ii) verity and duration of acne, skin type, psychosocial factors and

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original
work is properly cited, the use is non-commercial and no modifications or adaptations are made.

© 2025 The Author(s). Australasian Journal of Dermatology published by John Wiley & Sons Australia, Ltd on behalf of Australasian College of Dermatologists.

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lifestyle [18], most clinical guidelines focus solely on the use adjunctive treatment to prescription therapy in the Australian
of prescription medicines [19]. Adherence to acne prescription and New Zealand landscape.
medicines is poor, with an estimated global adherence rate of
50% [20]. Poor compliance is independently correlated with var-
ious factors, including the occurrence of side effects [20]. Factors 2   |   Dermocosmetics as Monotherapy
that may positively impact treatment adherence include the
use of dermocosmetics (also known as cosmeceuticals) such as Acne severity is commonly categorised into four levels of sever-
cleansers and moisturisers [20]. Increasingly, dermocosmetics ity: mild, moderate, severe and very severe. There are several acne
are being adopted for the management of acne to improve both severity assessment scales available. The Global Acne Grading
treatment adherence and outcomes and to minimise possible System (GAGS) is a simple and internationally recognised grad-
side effects from pharmacotherapy [21, 22]. ing system that divides the face, chest and back into six areas, and
the severity in each zone is then assessed on a scale of 0 to 4 (0,
Dermocosmetics can be applied either as a monotherapy for no lesions; 1, comedones; 2, papules; 3, pustules; and 4, nodules).
milder forms of acne, or as an adjunct to prescription medica- A total score for all six zones is then calculated, and the acne se-
tions in more severe forms [22, 23]. Once acne is under control, verity is classified as either mild [1–18], moderate [19–30], severe
dermocosmetics may continue to play a role in maintenance [31–38], or very severe (> 39) [26].
therapy and the prevention of new breakouts. Dermocosmetics
are becoming increasingly popular as an alternate management The use of dermocosmetics as monotherapy is appropriate for
strategy for patients with chronic acne, during periods of re- mild acne (especially prior to Dermatologist input); as mainte-
lapse, and in ameliorating side effects of other acne medications nance therapy following treatment with pharmaceutical drugs;
[24]. There is an increase in the number of published clinical or during pregnancy and lactation when prescription acne treat-
studies on the use of dermocosmetics in the management of ments are contraindicated [27, 28]. Moderate and severe acne
acne; however, these studies often have a small sample size and/ usually require treatment with pharmaceutical drugs; however,
or less rigorous study design and hence do not have the same dermocosmetics can be useful adjunctive treatments to these
strength of evidence as pharmaceutical studies. prescription medicines to either complement a drug's mode of
action and efficacy or to improve treatment tolerance and there-
Dermocosmetics contain active ingredients that have a measur- fore treatment adherence and optimise results.
able biological action on the skin [23, 25]. The active ingredients
target different aspects of acne pathophysiology, including aber- Mild acne can be managed by dermocosmetics (Table 1) as they
rant keratinisation, inflammation, sebum production and micro- have been shown to reduce acne lesions and improve global
biome imbalance. Such ingredients may also help manage acne assessment scores [11, 24, 29]. Dermocosmetics can also aid in
by protecting and improving epidermal barrier function. maintaining acne clearance after discontinuation of pharma-
ceutical treatment [11, 30]. Active ingredients aiming at improv-
The aim of this review is to discuss the use of dermocosmetics ing milder forms of acne target the key pathogenic pathways
in acne management, both as monotherapy for mild acne or as shown in Figure 1.

TABLE 1    |    Recommendations for the use of dermocosmetics as monotherapy and adjunctive therapy for the management of acne.

Type of
dermocosmetics
use Recommendation
Monotherapy Dermocosmetics including multitargeting ingredients (keratolytics + anti-­inflammatory, and/or anti
sebum production, and/or microbiome targeting ingredients) can be recommended as monotherapy for:
• Earlier forms of acne to aid the decrease of acne lesions, improve global acne, reduce skin oiliness,
improve PIHP while having a good tolerance
• Maintenance following prior acne treatments
Adjunctive therapy Dermocosmetics including multitargeting ingredients (keratolytics + anti-­inflammatory, and/or anti
sebum production, and/or microbiome targeting ingredients) may be recommended as adjunctive therapy:
• to augment prescription medical acne treatment mode of action
• to improve tolerability of acne treatments
Dermocosmetics with ingredients targeting skin barrier, skin microbiome
and inflammation and sebum production might be recommended in acne as
adjunct to acne topical and/or systemic treatments with a view to:
• improve tolerability of prescription acne treatments, especially retinoid-­based products (topical or
systemic)
• reduce irritation and/or adverse events from washes, cleansers, etc.
• reduce skin oiliness
• improve barrier function (corneometer and TEWL scores)
• further improve patient adherence, satisfaction and quality of life
Abbreviations: PIH, post-­inflammatory hyperpigmentation; TEWL, transepidermal water loss.

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FIGURE 1    |    Common acne active ingredients used in dermocosmetics.

3   |   Anti-­Inflammatory Agents Topical niacinamide has also been shown to improve overall
skin appearance in Caucasian women by reducing erythema,
3.1   |   Niacinamide wrinkles, yellowing and hyperpigmentation [37].

Niacinamide (also known as nicotinamide, 3-pyri­di­ne­car­box­

amide) is the physiologically active form of vitamin B3 [31]. It 3.2   |   Zinc Salts
has a range of dermatological therapeutic effects, including anti-­
inflammatory and anti-­bacterial properties. Its mechanisms of Zinc has been shown to act as an anti-­inflammatory on acne
action remain unclear; however, it is postulated to have a broad lesions through its inhibition of leucocyte chemotaxis [38].
range of activities, given that it is a key precursor of the coen- Clinical studies have demonstrated a benefit of both topical and
zymes NADH and NADPH [31]. systemic zinc in acne treatment. A systematic review and meta-­
analysis examining the efficacy of both topical and oral zinc in
Topical niacinamide 4% has been shown to reduce inflammatory acne treatment found that patients treated with either oral or
papules (−60%) and acne lesions (−52%) [32]. Three double-­blind topical zinc (either as monotherapy or as an adjunctive treat-
RCTs comparing topical niacinamide and the topical antibiotic ment) had a significant improvement in mean inflammatory
clindamycin showed that 4%–5% niacinamide has comparable papule count compared to those not treated with zinc [39]. Oral
efficacy on acne lesions and acne severity as 1%–2% clindamycin zinc at doses of 50 mg elemental zinc up to TDS was found to be
[32–34]. As such, niacinamide is used not only for its efficacy, effective in early studies [40].
but it also does not contribute to anti-­microbial resistance.
Topical Zinc has also been shown to benefit mild to moderate
Topical niacinamide can also reduce sebum production [35]. acne. A single-­blind trial of 47 patients showed a benefit in re-
In an in vitro study where viable human facial biopsies (from ducing the number of inflammatory lesions [41]. Moreover, a
facelift surgery) were treated with niacinamide, there was a sig- single-­blind, randomised study of 73 patients showed the topi-
nificant dose-­dependent reduction in total sebaceous lipid com- cal combination treatment erythromycin (4%) plus zinc acetate
ponents (namely triglycerides and fatty acids) [31, 36]. However, (1.2%) showed a benefit in reducing the number of inflamma-
there might be differences in the effect of niacinamide based tory lesions [42].
on skin type. Two separate double-­ blind placebo-­ controlled
studies examining the use of 2% niacinamide for 6 weeks were
conducted on Japanese participants and on Caucasian partici- 3.3   |   “Probiotic” Preparations
pants. Niacinamide was shown to significantly lower the sebum
excretion rate in the study with Japanese participants, but not in Probiotic lysates or fractions (which have pre-­biotic action or
the study with Caucasian participants. Conversely, niacinamide some similar probiotic activity to live bacteria) have been shown
reduced sebum levels in Caucasian participants, but not in their to have beneficial effects on the skin [43]. Although evidence is
Japanese counterparts [35]. weak and mostly derived from in vitro studies, Staphylococcus,

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Streptococcus, Lactococcus, Lactobacillus and Enterococcus people with comedonal acne showed that LHA is as effective
have shown potential to control acne [44]. A randomised at decreasing non-­inflammatory lesions as salicylic acid [49].
double-­blind split-­face RCT of 34 patients compared the top- Current Australian Therapeutic Guidelines for acne recom-
ical application of Lactobacillus-­ fermented Chamaecyparis mend the use of over-­the-­counter topical LHA for mild acne [52].
obtusa (LFCO) to tea tree oil; LFCO led to a greater reduc-
tion in inflammatory lesions (−65.3%) than tea tree oil (38%),
and reduced sebum excretion and sebaceous gland size [45]. 4.3   |   Alpha Hydroxy Acids (AHAs)
Lactobacillus fermentation of the Chamaecyparis obtusa plant
is thought to induce biochemical conversions of metabolites AHAs such as lactic acid and glycolic acid are used in acne man-
with enhanced antimicrobial or antioxidant activities [46]. agement as they limit follicular blockage, promote skin peeling
Furthermore, a 5% extract of Lactobacillus plantarum has been and reduce abnormal keratinisation [24, 56]. Low concentration
reported to exhibit anti-­acne effects, reducing skin erythema AHAs have a moisturising effect, while high concentrations
and acne lesions [47]. have keratolytic and exfoliating actions [56]. AHA-­containing
formulations have been shown to improve acne, and AHAs can
be used as a topical treatment for acne both as monotherapy and
4   |   Keratolytic Agents as adjunctive therapy [24]. Glycolic acid peels, either alone [57]
or in combination with retinoic acid [58–60], have been shown
Hyperkeratinisation occurs when follicles become occluded, to reduce acne lesions [61, 62].
preventing normal skin cell shedding and inducing microcom-
edones with the potential for progression to acneiform lesions.
Comedonal acne usually responds to topical keratolytic agents, 4.4   |   Retinaldehyde
and there are a number of keratolytic agents used in dermocos-
metics [48]. Topical retinoids (such as adapalene, isotretinoin and treti-
noin) are widely used prescription medicines for acne therapy
as they target multiple pathogenic mechanisms. They are anti-­
4.1   |   Salicylic Acid inflammatory and increase epithelial turnover, thus provid-
ing a comedolytic action [6]. There is strong evidence for their
Salicylic acid, a lipid-­soluble beta-­hydroxy acid, is used as a top- use in acne treatment, with several randomised, double-­blind,
ical treatment for acne both as monotherapy and as adjunctive placebo-­controlled studies demonstrating their efficacy [63–65].
therapy [24]. It is thought to dissolve intercellular lipids and Adapalene, isotretinoin and tretinoin are schedule 4 therapies
reduce comedones, thus ameliorating abnormal keratinisation (requiring prescription) and are associated with side effects in-
and reducing inflammation [24]. There are only a small number cluding erythema, irritation, dryness and peeling [6]. However,
of studies examining the effect of salicylic acid on acne [49–51]. retinaldehyde, a direct retinoic acid precursor, has been shown
A study of 30 acne patients showed that treatment with a 2% to be effective in reducing comedones and microcysts when
salicylic acid cleanser for 2 weeks significantly reduces come- combined with erythromycin [66], and has been shown to be
dones [51]. A study of 60 people with moderate to severe acne less irritating than other retinoids [60].
showed that the addition of 20% topical salicylic acid to oral
isotretinoin treatment significantly improves the clearance of
acne than monotherapy with isotretinoin [50]. Furthermore, 5   |   Antimicrobial Agents
a study of 20 comedonal acne patients showed that fortnightly
peels with salicylic acid significantly reduced noninflammatory Historically, C. acnes was thought to be the aetiological
lesions [49]. Current Australian Therapeutic Guidelines for acne agent of acne, leading to high prescription rates of antibiot-
recommend the use of over-­the-­counter topical salicylic acid for ics. Although data remain limited, growing evidence is as-
mild acne [52]. sociating acne with a disequilibrium in the composition of
the skin's microbiome [67]. For example, some C. acnes and
Staphylococcus epidermidis strains are thought to contribute
4.2   |   Lipohydroxy Acid to acne, while other strains are thought to promote healthy
skin by inhibiting the invasion of pathogens [67]. As such,
Lipohydroxy acid (LHA) is a lipophilic derivative of salicylic there is a need to manage C. acnes phylotypes, rather than
acid that exhibits slower penetration and better tolerability [53]. eradicate them completely. This is of high importance as there
Like salicylic acid, LHA has comedolytic properties due to its ex- has been a clear overuse of topical and/or systemic antibiotics
foliating effects [53]. In a small study of 28 acne-­prone women, leading to increased antibiotic resistance [68]. Indeed, anti-
LHA decreased the number and total size of microcomedones. biotic resistance has been associated with antibiotics used to
This effect was not seen in untreated controls [54]. A study of treat acne, and an increase in C. acnes resistance to antibiot-
80 patients with mild or moderate acne demonstrated that LHA ics is seen worldwide [69, 70]. Other antimicrobial agents, in-
was equally as effective as 5% benzoyl peroxide at decreasing cluding bakuchiol, probiotics, tea tree oil and decanediol, are
inflammatory and non-­inflammatory lesions and is a suitable commonly found in dermocosmetics and aid in the reduction
alternative for patients who are intolerant to benzoyl peroxide of acne-­c ausing microbes [24]. These agents may play a role in
or for patients who wish to avoid the unwanted bleaching effect the reduction of antibiotic resistance since they may, in some
of benzoyl peroxide [55]. Furthermore, a split-­face study of 20 cases, substitute for antibiotics in acne treatment.

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5.1   |   Benzoyl Peroxide facial skin pH, mirroring a chronic state of stratum corneum in-
stability, which may contribute to acne lesions [79]. Moreover,
Benzoyl peroxide shows a strong efficacy profile for mild acne some acne treatments such as benzoyl peroxide and retinoids
treatment [6, 71]. It acts by reducing C. acnes colonisation. can impact an intact skin barrier, leading to irritation and dry-
A study of 30 healthy subjects showed that daily use of a 6% ness [80]. These side effects can lead to a decrease in treat-
benzoyl peroxide cleanser decreases C. acnes colonies, includ- ment adherence or even treatment cessation. Dermocosmetics
ing erythromycin/tetracycline-­ resistant strains [72]. Current are an important tool in reducing these side effects. Products
Australian Therapeutic Guidelines for acne recommend the use such as moisturisers and non-­comedogenic cleansers can re-
of over-­the-­counter topical benzoyl peroxide for mild acne [52]. duce skin irritation [81]. Agents thought to aid in skin barrier
Similarly, European and United States guidelines also recom- protection include procerad, glycerine, shea butter, niacina-
mend benzoyl peroxide for the treatment of mild to moderate mide, ceramides, panthenol, mannose, Vitroscella filiformis/
acne [6, 71]. For moderate to severe acne, benzoyl peroxide is APF [23].
primarily recommended in combination with topical or sys-
temic antibiotics since it has been shown to be more effective in
combination with adapalene or clindamycin; the strength of evi- 7   |   Dermocosmetics as Adjunctive Therapy
dence to support its use with antibiotics is low to medium [6, 71].
However, benzoyl peroxide can have poor tolerance as it can Dermocosmetic products are useful as adjunctive therapy to
cause significant irritation, contact dermatitis and bleaching of pharmacological treatments (Table 1). The combined use of
clothes and hair [56, 73]. different dermocosmetic compounds augments the effect of
pharmaceuticals, presumably by targeting additional patho-
genic factors and increasing compliance. For example, the use
5.2   |   Tea Tree Oil of glycolic acid in conjunction with tretinoin has been shown
to improve treatment outcomes [24]. Moreover, a single-­centre,
Tea tree (Melaleuca alternifolia) oil is an extract from tea tree clinician-­blind, randomised study of 67 acne patients found that
leaves. It exhibits broad-­spectrum anti-­ microbial properties the clinical outcomes of 5% benzoyl peroxide treatment (reduc-
and has been shown to effectively treat mild acne [74]. In a tion in comedones, lesions and papules) were enhanced by the
placebo-­controlled randomised double-­blind trial performed in additional use of a topical combination cream containing octyl
60 patients with mild to moderate acne, topical 5% tea tree oil salicylic acid, linoleic acid, nicotinamide and piroctone olamine
significantly reduced total acne lesions and acne severity [75]. [82]. Furthermore, the use of dermocosmetics containing com-
Other comparative trials have shown that tea tree oil is better pounds such as salicylic acid and niacinamide has been shown
than placebo in reducing acne lesions and is equivalent to com- to reduce the need for benzoyl peroxide with no impact on the
parators including 5% benzoyl peroxide and 2% topical eryth- efficacy of mild to moderate acne [30].
romycin [74]. Tea tree oil has been reported to cause allergic
contact dermatitis in several studies [76]. As such, patch testing Dermocosmetics can help mitigate side effects of pharmacologi-
is recommended prior to use. cal treatments and improve treatment tolerability and treatment
adherence [30, 83–85]. Adherence to acne treatment is poor,
with a mean global adherence rate of 50% [20]. This is thought to
6   |   Sebum-­Reducing Agents be in part due to skin irritation and side effects caused by some
topical and systemic acne pharmaceuticals. Although there is
Sebum is comprised of wax, triglycerides, esters, squalene and limited supporting evidence, dermocosmetics are thought to
cholesterol. Excess sebum is one pathogenic pathway in acne help patients better tolerate topical prescription treatments,
development [11]. A range of dermocosmetic agents is used to thus improving compliance and patient quality of life [81]. For
reduce excess sebum production. example, a global survey of 3339 acne patients revealed that the
use of moisturisers and cleansers in addition to anti-­acne der-
mocosmetics had a positive effect on treatment adherence [20].
6.1   |   Antioxidants Moreover, a single-­arm study of 40 patients receiving pharmaco-
logical acne treatment found that the daily use of a sun protec-
Oxidative stress has been shown to play a key role in acne pro- tion cream improved adherence to pharmacological therapy and
gression [77]. Lipid peroxidation in sebum and the activation of improved acne symptoms [86].
immune cells in response to bacterial invasion potentially in-
crease reactive oxygen species (ROS) production [78]. As such, Dermocosmetics can also play a role in maintenance therapy
antioxidants have been trialled in the management of acne. as they can help prevent acne relapse (Table 1). The use of der-
Antioxidant agents that have shown some therapeutic effect on mocosmetics may reduce the need for pharmaceutical thera-
acne include fullerene, epigallocatechin-­3-­Gallate, vitamin C pies in the treatment of mild to moderate acne. For example, a
and vitamin E [11]. single-­centre, randomised, double-­blind RCT in 100 mild-­to-­
moderate acne patients demonstrated that the concomitant use
of a dermocosmetic containing salicylic acid, niacinamide and
6.2   |   Skin Barrier Protection thermal spring water reduced the quantity of benzoyl peroxide
needed to reach the same efficacy as benzoyl peroxide alone
Skin barrier function is often compromised in acne-­a ffected [30]. As such, appropriate dermocosmetics containing antimi-
skin [79]. Acne patients are more likely to exhibit increased crobial, anti-­inflammatory, antibiotic, or sebum-­controlling

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properties might be recommended to acne patients to com- excessive face washing or scrubbing will affect the epidermal
plement their pharmacological regimen. Selection of the barrier and exacerbate acne [5, 95], and further complicate the
most suitable adjunctive dermocosmetics should be guided use of prescription therapies such as retinoids. Optimal facial
by prescribers to avoid the use of inappropriate products. skin cleansing usually depends on the individual's skin condi-
Acne has been shown to worsen from inadequate product tions and the presence of comedonal lesions. Patients should
choice or products that cause irritation, photodermatitis, or be educated on the importance of maintaining appropriate
xerosis [87]. skin hygiene habits, especially following cessation of active
acne treatment plans to prevent recurrence. Appropriate fa-
cial skin cleaning can prevent excess sebum accumulation,
8   |   Patient Education one of the primary causes of acne.

Educating patients about which products to use can be chal- Evidence suggests that facial cleansing should be performed
lenging for healthcare professionals [23]. While many people twice a day to help reduce erythema, papules and total in-
with acne source information from their dermatologist (64.8%) flammatory lesions [99]. Cleansers have also shown benefit in
or family doctor (7.5%), the internet and social media are the removing mild to moderate truncal acne [100] and facial acne
second most commonly used sources of acne information, with [101]. Acne cleansers remove sebum and remove hair follicle
39.3% of people stating they source information this way [88]. plugs that obstruct the hair follicle [56]. To avoid skin irritation,
This leads to the propagation of myths and misconceptions acne cleansers should be soap-­free and pH-­balanced or acidic
around acne and its treatment and may, in turn, result in ineffec- cleansers containing foaming and emulsifying surfactants are
tive or inappropriate practices. Educational resources accessible suitable for acne-­prone skin [56].
to the public, particularly teenagers, are needed to address these
commonly held misperceptions and improve care and personal
practices [88–91]. Common areas where there is misconception 8.3   |   Acne and Prescription Medicines
surrounding acne include the effect of sun exposure, diet, hy-
giene, the need for prescription medicines and the impact of Management of moderate and severe acne requires the use of
acne on wellbeing. prescription medications, including topical and/or systemic
therapies, based on severity [102]. However, milder forms
of acne may be effectively managed with dermocosmetics.
8.1   |   Sun Exposure and Acne Dermocosmetics are an important component of dermatol-
ogists' therapeutic armamentarium, including in the setting
Although the cause and management of acne are similar of adjunct to prescription medicines, either to complement
globally, the Australian/New Zealand region presents a the mode of action of the medicines or to mitigate their side
unique treatment landscape due to higher levels of ultravi- effects.
olet (UV) radiation and elevated cumulative sun damage
caused by the outdoor lifestyle. Sun exposure and acne have
been postulated to have a dichotomous relationship, whereby 9   |   Limitations
acne may be improved with some sun exposure but can also
worsen [92]. UVA radiation, visible light and infrared light A limitation of this review is that the level of evidence for the
have been suggested to decrease C. acnes colonisation on use of all dermocosmetic products in the treatment of acne is
the skin and therefore reduce inflammation [93]. However, limited, and evidence mainly consists of lower quality stud-
there is no evidence to show that sunlight has a beneficial ies. However, the randomised controlled studies reviewed in
effect on acne [94, 95] and UV exposure is not considered this article demonstrate that dermocosmetics have a beneficial
an acne treatment [96]. UVB radiation may exacerbate acne role in the management of acne, either as a monotherapy, as
development as it increases the expression of proinflamma- adjuncts to medication, or as maintenance therapy post-­acne
tory cytokines such as IL-­8 and IL-­1β, leading to keratino- medication. This highlights the need for further randomised
cyte proliferation and sebum production [97]. Sunlight may controlled trials in this area to facilitate a greater level of
also aggravate post-­inflammatory hyperpigmentation (PIH) evidence.
or post-­inflammatory erythema following active acne [92].
Dermocosmetics may protect the skin against UV exposure,
reducing the development of PIH [23]. Sun exposure without a 10   |   Conclusions
broad-­spectrum UVB and high UVA protection SPF 30+ sun-
screen should be avoided. Moreover, several medications used Dermocosmetics can add significant value in the effective man-
to treat acne result in photosensitivity and therefore require agement of acne and have the potential to be effective monother-
minimisation of sun exposure combined with consistent use of apy in mild disease. Although the evidence base is limited, we
sunscreen [6]. believe that dermocosmetics can complement pharmaceutical-­
grade therapies in moderate or severe acne, either by enhancing
their efficacy or reducing their side effects and thereby increas-
8.2   |   Hygiene and Acne ing compliance. All clinicians, both in primary care and pre-
scribing dermatologists, should be abreast of dermocosmetics as
There is no evidence to support the misconception that acne effective monotherapy in mild acne and as adjuncts to pharma-
is caused by poor facial hygiene [95, 98]. On the contrary, cotherapy across all acne severities.

6 of 10 Australasian Journal of Dermatology, 2025

 14400960, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/ajd.14447 by Readcube (Labtiva Inc.), Wiley Online Library on [13/05/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
12. B. Dréno, V. Bettoli, E. Araviiskaia, M. Sanchez Viera, and A.
Bouloc, “The Influence of Exposome on Acne,” Journal of the European
Acknowledgements Academy of Dermatology and Venereology 32, no. 5 (2018): 812–819.
The authors thank Dulama Richani, PhD CMPP of WriteSource 13. R. W. Clayton, K. Göbel, C. M. Niessen, R. Paus, M. A. M. van
Medical Pty Ltd., Sydney, Australia, for providing medical writing sup- Steensel, and X. Lim, “Homeostasis of the Sebaceous Gland and
port. Medical writing support was funded by La Roche-­Posay in accor- Mechanisms of Acne Pathogenesis,” British Journal of Dermatology 181,
dance with Good Publication Practice (GPP2022) guidelines (https:// no. 4 (2019): 677–690.
www.acpjournals.org/doi/10.7326/M22-­1460).
14. J. H. Saurat, “Strategic Targets in Acne: The Comedone Switch in
Question,” Dermatology 231, no. 2 (2015): 105–111.
Conflicts of Interest
15. W. Shang, A. Y. Q. Tan, M. A. M. van Steensel, and X. Lim, “Aberrant
Ryan De Cruz: Advisory Boards for La Roche-­Posay, CeraVe, Novartis, Wnt Signaling Induces Comedo-­Like Changes in the Murine Upper
Eli Lilly. Presentations for Eli-­Lilly, La Roche-­Posay, CeraVe, Novartis, Hair Follicle,” Journal of Investigative Dermatology 142, no. 10 (2022):
MSD, Mayne Pharmaceuticals, iNova, AbbVie, Cutera, UCB. Rebecca 2603–2612.e6.
Nguyen: Novartis, Janssen, BMS, UCB, Amgen. Kurt Gebauer: Advisory
Board Member and Lecturer for Novartis, Leo, Janssen, Pfizer, BMS, 16. M. P. Cros, J. Mir-­
Pedrol, L. Toloza, et al., “New Insights Into
Lilly, Abbvie. Michael Lee: Advisory board honoraria from La-­Roche the Role of Cutibacterium Acnes-­ Derived Extracellular Vesicles in
Posay. Peggy Chen: Advisory Board fees from L'Oreal and travel/confer- Inflammatory Skin Disorders,” Scientific Reports 13, no. 1 (2023): 16058.
ence sponsorship from L'Oreal and Avene. Peggy Chen is an Editorial 17. B. Dreno, I. Dekio, H. Baldwin, et al., “Acne Microbiome: From
Board member of the Australasian Journal of Dermatology and a co-­ Phyla to Phylotypes,” Journal of the European Academy of Dermatology
author of this article. To minimise bias, she was excluded from all and Venereology 38, no. 4 (2024): 657–664.
editorial decision-­making related to the acceptance of this article for
publication. Delphine Kerob: Employee of La Roche-­Posay, a L'Oréal 18. H. P. Gollnick, “From New Findings in Acne Pathogenesis to
company. Philip Tong: Advisory board honoraria from La-­Roche Posay. New Approaches in Treatment,” Journal of the European Academy of
Anneliese Willems: Advisory Board Member for La Roche-­ Posay, Dermatology and Venereology 29, no. Suppl 5 (2015): 1–7.
Dercos, Amgen, Eczema Support Australia and QUM Alliance. 19. A. M. Layton, A. Alexis, H. Baldwin, et al., “The Personalized
Acne Treatment Tool—Recommendations to Facilitate a Patient-­
Data Availability Statement Centered Approach to Acne Management From the Personalizing Acne:
Consensus of Experts,” JAAD International 12 (2023): 60–69.
The authors have nothing to report.
20. B. Dréno, D. Thiboutot, H. Gollnick, et al., “Large-­Scale Worldwide
Observational Study of Adherence With Acne Therapy,” International
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