Abstract

Acne is a prevalent skin condition that affects millions of people worldwide. Topical anti-acne gels have become a popular treatment option because of their ease of use and effectiveness. This review provides an overview of the formulation, efficacy, and safety of anti-acne gels, highlighting their key ingredients, mechanisms of action, clinical trials, and regulatory considerations.

Keywords

Introduction

Acne vulgaris is a common chronic inflammatory skin condition that primarily affects the pilosebaceous unit (Mustafa, 2022; Zhang and Zhang, 2023). It is characterized by the presence of various lesions, including comedones (blackheads and whiteheads), papules, pustules, nodules, and cysts, which can lead to scarring and pigmentation (Mustafa, 2022; Zhang & Zhang, 2023). Acne typically appears in areas with a high concentration of sebaceous glands, such as the face, neck, chest, and upper back (Mustafa 2022).

Interestingly, while acne is often associated with adolescence, it can also affect individuals across different age groups. The onset of acne can occur as early as 6 or 7 years of age, depending on the onset of adrenarche, and may persist into adulthood (Katsambas et al., 2014). The prevalence of acne varies significantly across different populations and age groups. In adolescents, the prevalence is estimated to be between 70-87% (Tremolada, 2023). However, acne is not limited to teenagers, and is increasingly common in adults. Studies have reported varying prevalence rates among adult populations.

- A community-based study found 54% of women and 40% of men over 25 years had some degree of facial acne, with clinical acne present in 12% of women and 3% of men (Goulden et al., 1999).

- In a French study of women aged 25-40, the total acne prevalence was 41% (Poli et al., 2001).

- A study in China found lower prevalence rates compared to Caucasian populations, with peak prevalence of 46.8% in 19-year-olds (Zhang et al., 2012).

- In Denmark, clinical acne prevalence was 40.7% for men and 23.8% for women aged 15-22 years (Jemec et al., 2002).

- A study in Portugal reported a high prevalence of 61.5% in adults aged 20-60 (Semedo et al., 2016).

Acne vulgaris is a common skin condition for which multiple treatment options are available. Conventional treatments include topical agents such as benzoyl peroxide, azelaic acid, sulfur, antibiotics, and retinoids as well as systemic medications such as antibiotics, retinoids, and antiandrogens (Seth & Mishra, 2015). In severe cases, isotretinoin has emerged as one of the most effective treatments, although it is associated with various side effects that require careful consideration (Rajput and Anjankar, 2024).

Interestingly, alternative and complementary therapies have shown promise in the treatment of acne. Oral green tea extract and nicotinamide preparations gel efficacy in treating inflammatory acne, with minimal side effects (Marous et al., 2018). Additionally, novel approaches, such as negative air ion (NAIs) therapy and gold nanoshell-mediated photothermal therapy, have shown potential for treating recurrent and refractory acne (Han et al., 2022; Park et al., 2019). Aromatherapy treatments have also been explored as potential alternatives to conventional treatments (Bensouilah, 2002).

Formulation

Anti-acne gel formulations have gained significant attention in recent years due to their potential to provide effective treatment without the adverse effects associated with synthetic drugs. Various herbal extracts and natural ingredients have been explored for their anti-acne properties, demonstrating promising results in formulation development and efficacy studies.

Several studies have investigated the use of plant extracts in anti-acne gel formulations. For instance, Glycyrrhiza glabra extracts loaded with Carbopol 940 were used to prepare ethosomal gel formulations, which showed antibacterial potential against Propionibacterium acnes and sustained drug delivery (Hyder et al., 2021). Similarly, Murraya koeinigii leaf extracts were formulated into gels and evaluated for anti-acne properties, with results suggesting the potential for improved diffusion profiles by adding permeation enhancers (Roy et al., 2020). Interestingly, some studies have explored novel approaches to anti-acne gel formulations. For example, a modern herbal gel formulated with Punica granatum extracts demonstrated significant anti-acne activity against P. acnes, along with favorable physical characteristics and controlled release of active ingredients (Sharma, 2024). In contrast, a combination gel formulation of benzoyl peroxide 2.5% and clindamycin phosphate 1.2% has been approved in the USA for acne vulgaris treatment, showing efficacy across various severity grades and favorable skin tolerability (Rosso, 2010).

Efficacy

Topical treatment is the cornerstone of acne vulgaris management, with various options showing efficacy in clinical studies. The adapalene/benzoyl peroxide combination gel (0.1%/2.5% and 0.3%/2.5%) demonstrated superior efficacy, tolerability, and ease of use compared with other topical acne therapies (Emmerich et al., 2021). Azelaic acid (skinoren) has also shown reliable efficacy and safety, with anti-inflammatory, antibacterial, anti-keratinizing, antiandrogenic, and anti-tyrosinase properties, making it suitable for long-term acne treatment (Snarskaya, 2020).

 Interestingly, some studies have reported conflicting results regarding the efficacy of various topical treatments. For instance, 0.05% isotretinoin gel was found to be more efficacious than 0.1?apalene gel in treating mild-to-moderate acne vulgaris (Yousaf et al., 2023). Additionally, although 5?nzoyl peroxide gel showed better efficacy than 4% nicotinamide gel in one study (N et al., 2018), another study found no significant difference in efficacy between 2% clindamycin gel and 5% nicotinamide gel (Qayyum et al., 2022).

Safety

 Acne vulgaris treatment options have varying safety profiles, and both topical and systemic therapies are available. Topical treatments generally have a favorable safety profile, with mild local reactions being the most common side effects. For instance, benzoyl peroxide, which was previously considered potentially dangerous, is now considered safe for use during pregnancy (Pugashetti & Shinkai, 2013). Clascoterone 1% cream, a novel topical anti-androgen, has demonstrated a favorable safety profile in long-term studies, with erythema being the most common treatment-emergent local skin reaction (Kalabalik-Hoganson et al., 2021).

Interestingly, some natural alternatives have been explored for their potential in the treatment of acne. Juniperus communis wood oil and Trachyspermum ammi (ajwain) fruit essential oils are promising treatments for acne with minimal side effects (Ekakitie, 2024; Talebi et al., 2020). However, further research is required to fully establish their safety and efficacy.

Highlighting the key ingredients

Anti-acne gels typically contain various active ingredients that target different aspects of the pathogenesis of acne. Salicylic acid (SA) is a common ingredient, with a 1.5% concentration shown to be effective in reducing facial acne, particularly in mild to moderate cases (Zheng et al., 2013). Retinoids, including tretinoin, isotretinoin, adapalene, and tazarotene, are crucial components in acne management because of their ability to combat comedones and microcomedones, while providing anti-inflammatory effects (Thielitz et al., 2008). Natural ingredients, such as red betel leaf extract, containing tannins and flavonoids, have demonstrated antibacterial properties in anti-acne gel formulations (Deana & Minerva, 2024). Zinc compounds, particularly zinc-amino acid complexes, have shown promise owing to their antimicrobial, sebostatic, and demulcent activities (Abendrot et al., 2021). Platinum-based materials exhibit a broad spectrum of biological activities, including antioxidant and antimicrobial properties, making them potentially useful for the treatment of acne (Li et al., 2024). The most effective anti-acne gels often combine multiple active ingredients to target various aspects of the pathogenesis of acne. These include retinoids, salicylic acid, natural extracts, and metal-based compounds. The choice of ingredients and their concentrations should be carefully considered to maximize efficacy and minimize potential side effects. Future research should focus on developing multifunctional formulations that combine active ingredients with other properties, such as wound healing, to provide a comprehensive approach to acne treatment (Tören & Buzgo, 2023). 

Clinical trials

Topical treatments for acne vulgaris have evolved significantly, and various combinations and formulations have shown promise in clinical trials. Benzoyl peroxide, topical antibiotics, and topical retinoids used in combination provide the greatest efficacy and safety profile for mild-to-moderate acne (Gamble et al. 2012). Fixed-dose combination gels, such as adapalene 0.1% and benzoyl peroxide 2.5%, have demonstrated superior efficacy compared to monotherapies while maintaining a mild tolerability profile (Pariser, 2010). Interestingly, the efficacy of topical erythromycin has decreased over time, likely because of the development of antibiotic-resistant propionibacteria, whereas the efficacy of topical clindamycin has remained stable (Simonart & Dramaix, 2005). This highlights the importance of considering antibiotic resistance during acne treatment. Novel formulations and agents such as trifarotene and clascoterone have shown improved tolerability and address the hormonal etiology of acne (Drake et al., 2022). Combination therapies, particularly those that include benzoyl peroxide, have shown the most promising results in clinical trials. The use of the number needed to treat (NNT) analysis has revealed that the triple-combination clindamycin phosphate/adapalene/benzoyl peroxide gel and adapalene/benzoyl peroxide gel have the most favorable efficacy profiles (Feldman et al., 2024). However, further comparative studies are needed to define the optimal treatment algorithms that address safety, efficacy, and cost-effectiveness (Drake et al., 2022; Gamble et al., 2012).

CONCLUSION

Anti-acne gels have shown promising results in the treatment of acne vulgaris using various formulations and active ingredients. Andaliman ethanolic extract (AEE) in peel-off gel mask form has demonstrated effective anti-aging and anti-acne properties (T & Laila, 2018). Dapsone 7.5% gel has proven to be an effective and well-tolerated option for topical acne treatment in patients aged ?12 years (Al-Salama & Deeks, 2016). Natural plant-based formulations, such as Murraya koeinigii leaf extracts and garlic juice, have also shown potential as safe alternatives to antibiotics (Saptarini & Herawati, 2020; Saptarini & Herawati, 2017).

Hormonal treatments, such as flutamide 1% gel and spironolactone 5% gel, have demonstrated efficacy in the management of acne vulgaris (Ibrahim et al., 2019; Nassar et al., 2023). These findings suggest that targeting hormonal factors in the pathogenesis of acne is a viable approach. However, combination therapies such as azelaic acid with clindamycin or adapalene with benzoyl peroxide have gained popularity because of their complementary mechanisms of action and improved efficacy (Emmerich et al., 2021; Silina et al., 2016).

In conclusion, the development of anti-acne gels continues to evolve, with a focus on improving their efficacy, tolerability, and patient adherence. Although various formulations have shown promise, factors such as cost, availability, and potential side effects must be considered when selecting the most appropriate treatment option. Future research should aim to optimize formulations, explore novel combinations, and address barriers to patient adherence for more effective acne management.

ACKNOWLEDGEMENT

We would like to give acknowledge and give my warmest thanks to  Dr.Bhalekar S.M who made the work possible.

His guidance and advice carried me through all the stages of writing my Paper we would also like to thank you our

institute who gave us opportunity to do this paper.

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