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Strategic Targets in Acne, Update 2025: The Microcomedone Is Not Just a Plug, It Is an Egg
Bénédicte Oulès1, Jean Hilaire Saurat2
1Department of Dermatology, Hôpital Cochin AP-HP and the Centre-Université Paris Cité, Université de Paris Cité, Institut Cochin, CNRS UMR8104, INSERM U1016, Paris, France.
Dermatology (Basel, Switzerland)
|September 9, 2025
Summary
Acne research reveals that clinically non-lesional skin is the target for new treatments. Microcomedones, initially thought to be inert plugs, are now understood as the origin of acne lesions.
Area of Science:
- Dermatology
- Dermatopathology
- Acne Pathogenesis
Background:
- Maintaining pilosebaceous unit homeostasis is crucial for acne management.
- Acne-prone skin presents unique challenges for long-term treatment.
- The focus is shifting towards early, subclinical interventions.
Purpose of the Study:
- To review advances in acne research.
- To redefine strategic targets for novel topical acne treatments.
- To establish a basis for new therapeutic strategies.
Main Methods:
- Analysis of apparently uninvolved skin from acne patients.
- Sequential skin surface biopsies.
- Identification of subclinical lesions (microcomedones).
Main Results:
- Clinically non-lesional acne skin identified as a strategic target.
- Microcomedones are the root of all subsequent acne lesions.
- The 'comedo switch' concept explains microcomedone formation.
Conclusions:
- Microcomedones are not inert plugs but precursors to acne lesions.
- Targeting non-lesional skin and microcomedones offers new therapeutic avenues.
- Advances redefine strategies for effective topical acne treatments.
