From AAD: What's New in Acne and Rosacea?

Dermatologists gathered for the Acne and Rosea session at the 2025 American Academy of Dermatology in Orlando conference were treated to comprehensive updates on two prevalent skin conditions—acne and rosacea—presented by Julie Harper, MD, and Hilary Baldwin, MD, respectively. Here’s what’s new in understanding, treating, and managing these conditions.

Emerging Acne Therapies

The session led off was Dr. Julie Harper, a dermatologist at the Dermatology and Skin Care Center of Birmingham, who began by reveiwing the latest research within four well-known pillars of acne pathogenesis: sebum overproduction, follicular hyperkeratinization, Cutibacterium acnes (C. acnes) activity, and inflammation. However, she emphasized that the story for dermatologists goes deeper.

“It’s not just about excess sebum,” Dr. Harper noted. “We now understand that it’s also about qualitative changes in sebum, and that inflammation is coming from multiple cell types, not just one.”

Dr. Harper also explained how different strains of C. acnes play contrasting roles. Virulent strains drive inflammation, while healthy strains stimulate anti-inflammatory responses.

Advancements in Topical Treatments

Dr. Harper highlighted two newer topical treatments that current data suggests demonstrate both efficacy and speed, including triple fixed-dose combination of clindamycin, adapalene, and benzoyl peroxide.

“With this topical product, we’re seeing more than 50% reduction in inflammatory lesions by week four,” she said. A patient example showed significant improvement within weeks, underscoring the product’s potential.

She also highlighted clascoterone cream, a topical androgen receptor inhibitor. Despite slower action, its ability to reduce sebum production and inflammation makes it a useful option in both male and female patients.

Reexamining Isotretinoin

Isotretinoin continues to play a critical role in treating severe acne. Dr. Harper addressed emerging concerns about potential sexual side effects, referencing one large database study that found no significant risk of reported dysfunction in isotretinoin users compared to those on tetracyclines or topical treatments. She also revisited the notion that isotretinoin hinders wound healing, particularly in laser therapies for acne scars.

“It’s time to set isotretinoin free,” she said, and cited a study showing superior outcomes when fractional CO₂ laser treatments were performed during isotretinoin therapy compared to after.

Rosacea: A New Era of Understanding 

Dr. Hilary Baldwin, a clinical professor of medicine at Robert Wood Johnson Medical School at Rutgers University, and medical director of the Acne Treatment and Research Center in Brooklyn, used her lecture time to shed light on the often-overlooked “kissing cousin” of acne—rosacea. Her presentation began by discussing tetracyclines, emphasizing their anti-inflammatory properties rather than antibiotic effects.

Alternatives to Antibiotics

Dr. Baldwin outlined non-antibiotic alternatives, such as low-dose doxycycline (40 mg) and topical minocycline 1.5%. She introduced a new low-dose extended-release minocycline (40 mg) that combines immediate and delayed-release components, showing superior lesion reduction compared to its doxycycline counterpart in clinical trials.

The drug also proved to have no detectable impact on the microbiome, a critical consideration for long-term use.

Other Innovations

Dr. Baldwin presented groundbreaking findings on microencapsulated benzoyl peroxide, a slow-release formulation that reduces irritation in rosacea patients.

“By week two, patients experienced over a 40% reduction in inflammatory lesions,” she said, calling it a “jackrabbit start” in rosacea treatment.

Interestingly, the therapy normalizes the skin microbiome by decreasing Staphylococcus epidermidis levels and increasing C. acnes—reversing the microbial imbalance seen in rosacea patients.

Dr. Baldwin also talked about the emerging understanding of mast cells in rosacea.

“Mast cells are deeply embedded in both the inflammatory and neurovascular pathways of rosacea,” she said.

Therapies such as brimonidine, hydroxychloroquine, and botulinum toxin show promise in targeting mast cell activity and reducing symptoms like flushing and erythema.

Looking Ahead

Both experts emphasized the importance of continuing research to unravel the complexities of acne and rosacea. From targeting inflammation at the molecular level to tailoring therapies that restore microbial balance, the future of dermatologic care promises more effective and personalized treatment options.

“Rosacea doesn’t have to take a backseat anymore," said Dr. Baldwin, concluding her lecture. "We’re entering a new era where both science and patient outcomes are moving forward together.”  -by Eric Raible