Efficacy of topical medications for the treatment of moderate acne: a systematic review of randomized clinical trials

Abstract

Acne vulgaris is a chronic inflammatory condition that affects approximately 85% of young people, with the mild-to-moderate form being the most prevalent clinical presentation. In the pharmacological field, topical medications are the most widely used alternatives for acne treatment, aiming to reduce the number of lesions. Given this context, the objective of the present study was to evaluate which class of topical medication exhibits greater efficacy: conventional (clindamycin, erythromycin, retinoids, and benzoyl peroxide) or conservative (probiotics, prebiotics, salicylic acid, azelaic acid, or ceramide-based moisturizers). To this end, a systematic search was conducted in the PubMed, Embase, and Web of Science databases, following the PRISMA strategy via DeCS/MeSH descriptors. A total of 20,597 records were identified, of which 27 randomized clinical trials were fully eligible, with an overall sample of 6,202 patients. The results demonstrated that conventional interventions, such as the combination of clindamycin and benzoyl peroxide, have a faster and more potent action, with reductions in total lesions exceeding 70%. The use of tazarotene combined with clindamycin also stood out, with a 71% reduction in just 28 days. The conservative class, especially supramolecular salicylic acid and multi-target dermocosmetics, exhibited efficacy comparable to traditional standards (average reduction of ~54%), but with significantly superior local tolerability. Probiotics and prebiotics proved effective in global improvement (50%), albeit with a slower clinical response. It is concluded that the conventional class is more effective in the immediate numerical reduction of lesions, while the conservative class presents itself as a viable and strategic alternative by balancing clinical efficacy with a lower profile of adverse events, favoring treatment adherence.