Acne treatments have stuck to the same basic ideas for decades because the main causes of acne have not changed much, and the drugs that target them still work well enough for most people.
Acne happens when oil glands make too much oil, dead skin cells clog pores, and bacteria like Cutibacterium acnes grow inside those blockages, leading to swelling and pimples. This process has been understood since the mid-1900s, and it stays the same no matter the year.[5] Doctors focus on four steps to fight it: cut oil production, unclog pores, kill bacteria, and calm swelling. Topical creams with benzoyl peroxide kill bacteria right on the skin. Retinoids like tretinoin stop pores from clogging by speeding up skin cell turnover. Antibiotics in creams or pills reduce bacterial growth. For bad cases, a strong drug called isotretinoin shrinks oil glands from the inside out.[3]
These treatments started becoming standard in the 1960s and 1970s. Antibiotics were already used for infections long before that, going back thousands of years with molds and plants, but modern ones fit acne perfectly.[1] Isotretinoin came in the 1980s and became the go-to for severe acne that nothing else fixes.[3] They work because they hit the core problem directly, and acne biology has not shifted. Most people see results without needing anything new.
Pharma companies keep making the same types of drugs because they are safe, cheap to produce, and approved by regulators. Guidelines from skin doctors rarely change them since studies keep proving they help. Even with side effects like dry skin or antibiotic resistance worries, the old methods beat doing nothing.
New ideas pop up, like creams with live good bacteria called lactobacilli to fight bad ones without killing everything.[2] Plant oils from tea tree or turmeric show promise in lab tests.[4] But these are not main treatments yet. They need more big trials to prove they beat the standards, and doctors stick to what they know works for quick fixes. For scars left by old acne, new fixes like subcision exist, but that is after the pimples, not during.[6]
The skin microbiome, those tiny bugs on our face, changes over time and might explain why some get acne strains early.[5] Still, daily care with the classic drugs handles most cases fine. Research pushes for tweaks, like lower doses of isotretinoin or better combos, but the foundation stays the same.[3]
Sources
https://en.wikipedia.org/wiki/Antibiotic
https://www.drugdiscoverynews.com/a-live-bacteria-treatment-for-acne-15924
https://clinicaltrials.gov/study/NCT07296523
https://pmc.ncbi.nlm.nih.gov/articles/PMC12729506/
https://www.sciencedaily.com/terms/acne_vulgaris.htm
https://onlinelibrary.wiley.com/doi/pdf/10.1111/jocd.16629
