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52% of people who quit acne treatment quit for ineffectiveness, within 3 months.

Malassezia folliculitis present in 28.8% of clinically-diagnosed acne.

MF commonly misdiagnosed as acne, persists on acne meds, associated with antibiotic use.

MF mimicry leads to inappropriate antibiotic use.

Acne = loss of C. acnes phylotype balance + dysbiosis, not hyperproliferation; antibiotics induce dysbiosis.

IA1 phylotype biofilm + increased antibiotic tolerance.

Pre/pro/postbiotic systematic review: postbiotic reduces lesions more than control but between-group difference nonsignificant; adjuncts only.

BP vehicle irritancy (surfactants/preservatives/alcohols); low-% formula without them well-tolerated.

Azelaic acid — 4 mechanisms (antimicrobial, tyrosinase inhibition, free-radical scavenging, reduced neutrophil ROS).

Azelaic acid also keratolytic.

Azelaic acid probably less effective than benzoyl peroxide on PGA (Cochrane RR 0.82).

Azelaic acid is first-line topical alongside retinoids and BP.

Azelaic acid antifungal activity + exploratory support in seborrheic dermatitis (Malassezia-driven).

Hidradenitis suppurativa >3x more prevalent in Black vs White; more severe, longer diagnostic delay.

An open-label randomized trial of an at-home 660-nm red/415-nm blue LED device for mild-to-moderate inflammatory acne found significant inflammatory-lesion reduction at 4 and 8 weeks; total-lesion reduction was significant with the red/blue device but not the blue-only comparator, and there was no significant between-group difference for total, inflammatory, or noninflammatory lesion reduction.

FDA 510(k) K210948 describes Omnilux CLEAR as an over-the-counter mask intended to emit red and blue LED energy for mild-to-moderate acne vulgaris of the face; the FDA comparison table lists approximately 630-nm red and 412.5-nm blue wavelengths.

A clay mask formulated with kaolin and bentonite, used twice weekly for 4 weeks by 75 adults with oily/combination skin, produced significant improvements in acne lesion counts, sebum content, stratum corneum hydration, and TEWL, with reduced dryness/irritation and high self-reported tolerability; pore area and porphyrin area did not change significantly.

A single-session 30% salicylic acid peel performed equally to Jessner's solution for acne and post-acne hyperpigmentation; complications were burning/stinging/exfoliation; PIH occurred in 1 of 36 subjects.

A 2-MNG-containing depigmenting serum treats post-inflammatory hyperpigmentation in subjects of Fitzpatrick phototype IV-VI with acne-related PIH.