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Open research questions in Acne and Rosacea Treatments and Effects

32 unresolved questions extracted from the limitations and future-work sections of 328 Acne and Rosacea Treatments and Effects papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • lesion development. Benzoyl peroxide remains new important for inflammatory relapse prevention, antimicrobial activity, and antibiotic stewardship. Direct head-to-head maintenance evidence is limited, but available studies and retinoid-based guideline-based maintenance, particularly when long-term relapse prevention is the goal. Retinoid–benzoyl peroxide combinations appear to provide the strongest maintenance strategy for relapseprone patients, especially after moderate-to-severe acne, oral should antibiotics, be individualized according tolerability, pregnancy status, relapse pattern, and adherence. isotretinoin. Treatment lesion favor type, or to REFERENCES I. II. III. IV. V. VI. VII. Leung AKC, Barankin B, Lam JM, Leong KF, Hon KL. Dermatology: how to manage acne vulgaris. Drugs Context. 2021;10. doi:10.7573/dic.2021-8-6 Bettoli V, Borghi A, Zauli S, Toni G, Ricci M, Giari S, Virgili A. Maintenance therapy for acne vulgaris: efficacy of a 12-month treatment with adapalenebenzoyl peroxide after oral isotretinoin and a review of the literature. Dermatology. 2013;227:97-102. doi:10.1159/000350820 Leyden J. Recent advances in the use of adapalene 0.1%/benzoyl peroxide 2.5% to treat patients with moderate to severe acne. J Dermatolog Treat. 2016;27:S13-S14. doi:10.3109/09546634.2016.1145338 Emmerich V, Purvis C, Feldman S. An overview of adapalene and benzoyl peroxide once-daily topical gel as a therapeutic option for acne. Expert Opin 2021;22:1661-1667. Pharmacother. doi:10.1080/14656566.2021.1939678 Ullah A, Muhammad A, Mehmood F, Farooq H, Ahmad B, Haq AB, et al. Comparing the efficacy of topical 4% benzoyl peroxide versus topical 0.1% adapalene for treatment of acne vulgaris in skin of color population: a South Asian perspective. Cureus. 2024;16:e55555. doi:10.7759/cureus.55555 Fahim B, Shaikh MA, Ejaz T, Batool P. Evaluating topical treatments for mild to moderate acne: a cross-sectional study. Ukr J Med Biol Sport. 2024. doi:10.63341/ujmbs/4.2024.016 Aschoff R, Möller S, Haase R, Kuske M. Tolerability and efficacy of clindamycin/tretinoin versus adapalene/benzoyl peroxide in the treatment of acne vulgaris. J Drugs Dermatol. 2021;20:295- 301. doi:10.36849/JDD.2021.5641 VIII. Mavranezouli I, Daly C, Welton N, Deshpande S, Berg L, Bromham N, et al. A systematic review and network meta-analysis of topical pharmacological, oral pharmacological, physical and combined treatments for acne vulgaris. Br J Dermatol. 2022;187:639-649.

    Topical Retinoids Versus Benzoyl Peroxide in Acne Maintenance Therapy: Comparative Role, Evidence, And Practical Use · 2026 · DOI

  • The study included a substantial sample of 3,272 adolescents, ensuring that the results are representative of a wide range of demographic groups and enhancing the generalizability of the findings. The research is unique in its focus on Honduran adolescents, providing valuable insights into the psychosocial impact of acne in a Latin American context, which has been largely underrepresented in the literature. The inclusion of various ethnic groups, including Mestizo, White, Indigenous, and others, allowed for the exploration of ethnic disparities in the impact of acne on quality of life, contributing to a more nuanced under- standing of the condition’s effects. The study employed the Cardiff Acne Disability Index (CADI), a well-established, validated tool for assessing acne-related quality of life, ensuring that the data collected was reliable and robust. The study used multivariate analysis to control confounding variables, providing more accurate and meaning- ful results that account for multiple factors influencing acne-related quality of life. The data collection was conducted during the COVID-19 pandemic, when sanitary restrictions limited in- person research activities and required the use of remote data collection methods. As a cross-sectional study, research can only identify associations rather than causal relationships. The impact of acne on adolescents’ quality of life may vary over time, but this study does not account for those changes. The non-probability snowball sampling method introduces the possibility of selection bias. Participants were recruited through social networks, which may have resulted in an overrepresentation of certain social groups, limiting the generalizability of the findings. Furthermore, since information on school type and detailed socioeconomic char- acteristics was not collected, it was not possible to assess the extent of this potential bias. Another limitation of this study is the lack of clinical validation for acne and depression, as well as the potential influence of confounding factors such as stress related to the COVID-19 pandemic. The classification of acne type was included as a self-reported descriptive variable, supported by standardized visual aids, rather than as a clinically validated diagnostic measure. The visual aids used for acne self-identification were not stratified accord- ing to Fitzpatrick skin phototypes, which may have introduced misclassification bias, particularly in a population with diverse ethnic backgrounds. This limitation may affect the accuracy of self-reported acne type and severity. The absence of detailed socioeconomic data limits the ability to assess how these factors may have influenced Eur. J. Ment. Health 2026, 21, e0057, 1–14. 10 E. ESPINOZA-TURCIOS ET AL. Impact of Acne on Quality of Life the results. Future studies could benefit from incorporating more specific measures of socioeconomic status to further understand its role.

    Impact of Acne on Quality of Life in Adolescents of Honduras: A Cross-Sectional Analytical Study · 2026 · DOI

  • 2025 Ma et al. (36) Multicenter, randomized, double-blind, placebo-controlled trial Level 1 87 patients with refractory erythema of rosacea (73 completed) Oral placebo, low-dose gabapentin (200 mg three times daily), high-dose gabapentin (300 mg three times daily) for 12 weeks with regular moisturizing High-dose gabapentin significantly improved flushing and redness Small sample size, lack of partial relapse data g-aminobutyric acid (GABA) derivatives 2025 Wei et al.

    Therapeutic progress in rosacea: targeting the neuro-vascular-immune triad · 2026 · DOI

  • if results are insufficient: consider combination with systemic azithromycin Consider for ocular rosacea artificial tears and eyelid hygiene, and if results are not sufficient consider topical fusidic acid gel or (only by ophthalmologist) ciclosporin ophthalmic emulsion Children consider for papules/pustules topical metronidazole cream/gel bid. If results are insufficient: consider systemic metronidazole or tetracycline Refer to ophthalmologist when ocular rosacea is suspected Gambar 11.

    Rosacea: Gejala, Diagnosis, dan Tata Laksana · 2026 · DOI

  • Clinical assessment involving human volunteers must be conducted safety and anti-acne the effectiveness of the formulation. to validate Long-term stability assessments are necessary ascertain shelf life and suitable storage conditions. to It is essential to optimize the concentration of herbal extracts to attain the highest therapeutic efficacy. The addition of other herbal components, such as aloe vera and turmeric, may improve anti-acne and soothing properties. In-vitro antimicrobial tests should be carried out against acne-related microorganisms, including Cutibacterium acnes. Studies on dermatological safety and skin irritation must be performed to confirm compatibility with all skin types. www.ejpmr.com │ Vol 13, Issue 5, 2026. │ ISO 9001:2015 Certified Journal │ 70 Mansi et al.

    FORMULATION AND EVALUATION OF ACNE FACE WASH CONTAINING TULSI, NEEM, AND ACTIVATED CHARCOAL · 2026 · DOI

  • Despite certain limitations were noted in the current study. the successful formulation and evaluation, The formulation was not assessed through clinical trials involving human subjects, which restricts the validation of its real-world safety and effectiveness. The antimicrobial activity was not specifically evaluated like acne-causing against Cutibacterium acnes. organisms primary Only short-term stability assessments were conducted, which are inadequate to ascertain the long-term stability and shelf life of the product. Variability in herbal components due to differences in geographical origin, harvesting methods, and processing may influence the consistency of the formulation. Comprehensive dermatological assessments, such as studies on skin irritation and sensitivity, were not performed, which are crucial for topical formulations. 8. REFERENCES 1. Koli DS, Mane AN, Kumbhar VB, Shaha KS. Formulation & evaluation of herbal anti-acne face wash. World J Pharm Pharm Sci., 2016 Apr 15; 5(6): 2001-7. 2. Singh HP, Samnhotra N, Gullaiya S, Kaur I. Antiacne synergistic herbal face wash gel: formulation, evaluation and stability studies. World Journal of Pharmaceutical Research, 2015 Jun 24; 4(9): 1261-73. 3. Jadhav PA. Formulation and evaluation of anti-acne face wash gel. World Journal of Pharmacy and Pharmaceutical Sciences. 2017 Mar 19; 6(5): 2278-4357. 4. Mendhekar SY, Badhe PV. Development and Evaluation of a Polyherbal Face Wash Gel. 5. Gulzar B, Ahmad M, Bukhari DA, Bibi Z, Ullah A, Rehman A. Preliminary evaluation of the anti-acne potential of herbal and fruit extracts and formulated creams. Current Research in Biotechnology, 2025 Oct 10: 100339. 6. Sutar AK, Deshmukh AS. A Comprehensive Review on Acne and their Herbal Remedies. International 7. Ni Putu Ratna K, Afifah FN, Kartika T, Prianto AH. Neem oil (Azadirachta indica A. juss) as a potential natural active compound in cosmetic properties title. Biomass-Based Cosmetics: Research Trends and Future Outlook, 2024 Jun 30: 325-50. 8. Sharma M, Gupta AK, Minocha S. A review on acne. J Biomed Pharm Res., 2015; 4(1): 121-6. 9. Sanchez N, Fayne R, Burroway B. Charcoal: An ancient material with a new face. Clinics in Dermatology, 2020 Mar 1; 38(2): 262-4. 10. Khot S, More S, Adnaik P. FORMULATION AND EVALUATION ANTI-ACNE HERBAL PEEL OFF MASK. 11. Cohen MM. Tulsi – Ocimum sanctum: A herb for all reasons. J Ayurveda Integr Med., 2014; 5(4): 251–259. 12. Prakash P, Gupta N. Therapeutic uses of Ocimum sanctum Linn (Tulsi) with a note on eugenol and its pharmacological actions. Indian J Physiol Pharmacol. 2005; 49(2): 125–131. 13. Biswas K, Chattopadhyay I, Banerjee RK, Bandyopadhyay U.

    FORMULATION AND EVALUATION OF ACNE FACE WASH CONTAINING TULSI, NEEM, AND ACTIVATED CHARCOAL · 2026 · DOI

  • • For mild acne: Start with BPO 2.5%–3.75% monotherapy once daily. • For moderate-to-severe acne: Prescribe a fixed-dose combination: either adapalene 0.1%/BPO 2.5% or clindamycin 1.2%/BPO 3.75% as first-line. • For severe acne or when rapid response is needed: Consider the triple combination CAB gel (if available), which offers the highest efficacy. • For scar prevention: Adapalene/BPO (0.3%/2.5%) is strongly recommended based on 48- week scar reduction data. • Future research: Independent, head-to-head trials comparing CAB versus oral antibiotics + topical BPO, and studies in diverse ethnic populations, are needed. REFERENCES 1. Lamel SA, Sivamani R, Rahvar M, Maibach H (2015) Evaluating clinical trial design: systematic review of randomized vehicle-controlled trials for determining efficacy of benzoyl peroxide topical therapy for acne. Archives of Dermatological Research. https://doi.org/10.1007/s00403-015-1568-9 2. Kawashima M, Sato S, Furukawa F, et al (2017) Twelve‐week, multicenter, placebo‐ controlled, randomized, double‐blind, parallel‐group, comparative phase II/III study of benzoyl peroxide gel in patients with acne vulgaris: A secondary publication. Journal of dermatology (Print). https://doi.org/10.1111/1346-8138.13798 The International Journal of Medical Science and Health Research Downloaded from theInternationalmedicaljournal.org. For personal use only. No other uses without permission. Copyright © International Medical Journal Corp. Ltd. All rights reserved 475 Research Article Volume 48, Issue No. 01. 2026 E-ISSN : 3048-1368 P-ISSN : 3048-1376 3. Kawashima M, Hashimoto H, Saenz AAA, et al (2014) Is benzoyl peroxide 3% topical gel effective and safe in the treatment of acne vulgaris in Japanese patients? A multicenter, randomized, double‐blind, vehicle‐controlled, parallel‐group study.

    The Comprehensive Systematic Review of Use of Benzoyl Peroxide as Monotherapy or Combination Therapy for Acne · 2026 · DOI

  • Further investigation of whether an agreed upon and not currently recommended upper limit for CK level that is tolerable can ensure safer follow-up during isotretinoin treatment is needed.

    Elevated serum creatine kinase levels in acne vulgaris patients treated with isotretinoin: A retrospective single-center study · 2021 · DOI

  • Direct head-to-head maintenance evidence is limited, but available studies and retinoid-based guideline-based maintenance, particularly when long-term relapse prevention is the goal.

    Topical Retinoids Versus Benzoyl Peroxide in Acne Maintenance Therapy: Comparative Role, Evidence, And Practical Use · 2026 · DOI

  • Because this was a cross-sectional case- control study, temporal direction could not be established; psychiatric distress and disordered eating may precede acne, result from acne, or relate bidirectionally.

    Multidimensional assessment of acne vulgaris: links between psychiatric symptoms, disordered eating, and dermatologic severity · 2026 · DOI

  • [16] To the best of our knowledge, the salusin-α, salusin-β, IL-35, and IL-39 levels have not been studied in patients with rosacea.

    The role of salusins and interleukin 12 family in the rosacea pathogenesis · 2023 · DOI

  • Coexistence with polymorphic light eruption and rosacea have not been reported to date as far as we know, and here we present a case displaying that this coexistence should come to mind in patients if extrafacial rosacea is considered.

    Is Extrafacial Rosacea or the Coexistence of Rosacea and Polymorph Light Eruption? · 2020 · DOI

  • Exact pathogenesis is not yet elucidated, although all of these are influences due to the imbalance of the innate immune system, the overgrowth of skin coma and the aberrant neurovascular signaling.

    Adjuvant therapies to improve the results of pharmacological therapies in rosacea · 2018 · DOI

  • Rosacea is a common condition in this country, remains unknown, and as until recently no reliable cause of treatment has existed it is not surprising that the powerful anti-inflammatory steroids should be tried.

    Adverse Effect of Topical Fluorinated Corticosteroids in Rosacea · 1969 · DOI

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32 open questions have been extracted from the limitations and future-work passages of 328 Acne and Rosacea Treatments and Effects papers in our library. Each one below links back to the study that raised it, so you can read the original claim in context.

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