The Role of Dermocosmetics in Acne Management: Implications for Clinical Practice in Brazil

Abstract

Acne is a prevalent skin condition worldwide, affecting diverse populations, including Brazil. Although acne guidelines are well established for topical and/or systemic medications, recommendations regarding dermocosmetics, which have become increasingly important in acne management, remain limited. This review examines the role of dermocosmetics within acne treatment protocols and provides practical guidance for their integration into skincare routines alongside conventional therapies. Six dermatology experts conducted structured PubMed literature searches (2012–2024) and discussed the findings during expert meetings focused on acne management and dermocosmetics in the Brazilian context. Despite increasing evidence of benefit, the role of dermocosmetics remains underreported, with systemic treatments predominating. Acne pathophysiology is complex with four main pillars: hyperkeratinization of the pilosebaceous gland infundibulum, inflammation, overactivity of sebaceous glands, and microbiome imbalance in the context of an altered skin barrier. Advances in acne microbiome research highlight the importance of targeting dysbiosis, with new treatments exploring pre-, pro-, and postbiotics and bacteriophages. Dermocosmetics containing key active ingredients can address these multifactorial targets of acne, including excessive sebum production, hyperkeratinization, inflammation, and skin barrier and microbiome imbalance. They have been shown in clinical studies to be beneficial as monotherapy for mild cases, as maintenance therapy, or as adjuncts to acne medications. Due to their safety and tolerability profile, dermocosmetics are especially valuable for specific populations, such as pregnant women and prepubertal patients. Published evidence and expert clinical consensus support integrating dermocosmetics into daily routines to enhance acne control, patient adherence, and quality of life. Effective patient education on skincare regimens prevents treatment-related issues and optimizes outcomes. Incorporating dermocosmetics and improving patient education may further optimize these benefits.

Introduction

Acne is a chronic, multifactorial inflammatory disease of pilosebaceous follicles, affecting individuals across different age groups and ethnicities worldwide.^1,2 It is the eighth most prevalent disease worldwide,^1,3 and in Brazil, it is a major concern in dermatological consultations. A Brazilian Society of Dermatology (SBD) survey analyzed data from 9629 patients (mean age of 42.8 ± 21.1 years), revealing that acne was the most frequent primary diagnosis, accounting for 8.0% of all dermatological consultations.⁴

Acne pathogenesis is complex and closely linked to natural environmental factors.⁵ Brazil’s tropical and subtropical climates, characterized by high temperatures and humidity, play an important role in acne’s pathogenesis and contribute to its recurrence. Studies have demonstrated that acne worsens in hot, humid conditions, such as during the summer and rainy seasons.^6,7 Sun exposure further induces or aggravates acne.^5,7 The combination of environmental stressors – intensive UV radiation, heat, and humidity – aggravates inflammatory responses in the skin, increases sebaceous gland activity and skin oiliness, and disrupts the skin’s barrier function, promoting the imbalance between acne-virulent phylotypes of Cutibacterium acnes (C. acnes IA1), a key player in the acne microbiome, and Staphylococcus epidermidis, thereby contributing to a cyclical worsening of acne symptoms.^5–8

This tropical environment is also conducive to acne-induced post-inflammatory hyperpigmentation. The acne-related inflammatory processes stimulate excess melanogenesis and uneven melanin dispersion, leading to post-acne hyperpigmentation (PAH) and acne-induced erythema (AIE) across all skin tones.⁹ Additionally, Brazil’s highly admixed population presents a broad range of Fitzpatrick skin phototypes (I to VI),¹⁰ making acne management particularly challenging.^11,12 PAH is especially prevalent among individuals with skin phototypes III or higher and can be long-lasting.⁹ Consequently, many patients in Brazil are affected by PAH and typically seek rapid improvement.¹³

Acne and its sequelae, such as PAH and scarring, often lead to psychological, emotional, and appearance-related distress, negatively affecting quality of life, self-esteem and contributing to anxiety and depression, particularly among adolescents and young adults.^11,13–19 Studies have shown that acne patients frequently perceive PAH as equally or more bothersome than the acne itself due to its prolonged impact on skin appearance.^10,14 Furthermore, acne of any severity can lead to scarring, which places a considerable psychological and psychosocial burden on patients’ lives.^19,20

Current challenges in preventing acne sequelae include delayed treatment, inadequate communication between patients and physicians, poor adherence to treatment, and lesion excoriation (often referred to as “picking”).¹⁹ Early and effective intervention is essential to reduce the risk of physical, psychiatric, and psychosocial complications.^1,15,18 Additionally, treatment success in chronic skin conditions, including acne, is highly dependent on patient adherence^21–23 and careful treatment selection, considering factors such as acne severity, patient characteristics (including skin phototype and reactivity), potential side effects, and the patient’s preferences and expectations regarding treatment.^24,25 Among the factors that may enhance adherence is the use of dermocosmetic products.^12,26–28

Dermocosmetics, also referred to as cosmeceuticals, are topical formulations positioned at the interface between cosmetics and pharmaceuticals, containing biologically active ingredients capable of modulating skin physiology and contributing to therapeutic skin benefits.^29–32 Although not formally classified as drugs by most regulatory agencies, these products have become an integral component of dermatologic practice because of their established adjunctive role in disease management and maintenance therapy.^29–32 In acne management, these products are formulated with active ingredients targeting multiple aspects of acne pathophysiology, including seborrhea, inflammation, hyperkeratosis, skin barrier dysfunction, microbiome imbalance, and pigmentary alterations.^29,30 Their incorporation into acne management has become increasingly relevant, particularly because preservation of the skin barrier and microbiome homeostasis is now recognized as a key component in the evolution of acne treatment. In addition, dermocosmetics may improve treatment tolerability, reduce cutaneous irritation associated with anti-acne medications, and enhance long-term adherence.^24,27,29,30

Despite the chronic and heterogeneous nature of acne, current clinical guidelines still provide limited guidance for personalized or long-term management, offering only generalized recommendations for optimizing skincare regimens, whether using dermocosmetics in conjunction with prescribed medications or alone.^12,33 Previous evaluations of acne treatment guidelines identified methodological variability and potential bias, highlighting gaps in evidence-based and patient involvement in the development process.³⁴ Although guidelines published between 2017 and 2024 showed improved methodological rigor, limitations persist regarding maintenance therapy, treatment adherence, and integration of dermocosmetics into acne management.^12,22,33

These gaps are particularly relevant in Brazil, a country characterized by marked ethnic admixture, broad skin phototype diversity, high ultraviolet exposure, and a substantial burden of post-inflammatory hyperpigmentation among patients with acne. Nevertheless, evidence-based recommendations specifically addressing the selection and use of dermocosmetics in the Brazilian population remain scarce. Therefore, in the absence of comprehensive national acne guidelines, the authors have opted to base their discussion on the therapeutic algorithm proposed by the Ibero-Latin American Group of Acne Studies (GILEA), one of the first acne treatment frameworks to formally incorporate dermocosmetics into routine acne care.¹⁸ This algorithm emphasizes the significance of skin cleansers, skin barrier repair lotions and creams, dermocosmetics with keratolytic effects, and sunscreens as key components of the skincare routine for acne patients.¹⁸ More recently, dermocosmetics have been discussed in a general manner in other guidelines, but specific literature guiding the use of dermocosmetics in the Brazilian acne population remains limited.^22,35–37 This algorithm recognizes the critical role of dermocosmetics in acne management, particularly for patients with darker skin types who are at higher risk of PAH.¹⁸

This review aims to discuss the importance of dermocosmetics in acne management and provide practical guidance on their implementation, with particular relevance to clinical practice in Brazil.

Methodology

This paper was developed by six dermatologists: five Brazilian experts with extensive experience in acne treatment, focusing on Brazilian population specifics, and one international dermatologist with recognized expertise in acne and the skin microbiome. The methodology consisted of an in-depth investigation into the most relevant topics and unmet needs in acne clinical management, particularly regarding the role of dermocosmetics in treatment strategies.

The authors conducted structured PubMed literature searches covering publications from 2012 to June 2024 using combinations of terms related to acne, dermocosmetics, microbiome, skin barrier, adherence, Brazil, and acne treatment. The research was based on scientific evidence and included original research, clinical guidelines, algorithms, relevant reviews, and evidence-based recommendations based on the current clinical practice.

The findings from the literature review were discussed during a face-to-face expert meeting addressing multiple aspects of acne management, including its contextualization in Brazil and Latin America, the specificities of Brazilian skin, current treatment guidelines, the role of the microbiome and the skin barrier, recent therapeutic advances, and the role of dermocosmetics in the management of acne in Brazil. Recommendations were based on published evidence and expert clinical consensus.

After the meeting, asynchronous reviews and discussions were conducted to refine the manuscript content and develop the proposed infographics.

Results and Discussion

Literature Insights on Acne Management in Brazilian Clinical Practice

A large-scale survey of 596 Brazilian dermatologists was conducted in 2014 and revealed that a significant proportion of Brazilian dermatologists prescribed systemic therapy (28%), particularly isotretinoin (15.8%), for comedonal acne, with even higher rates for mild to moderate papulopustular acne (64% opted for systemic treatment, with 22.1% choosing isotretinoin).²¹ This trend continued for severe papulopustular and nodulocystic acne, with oral isotretinoin being the primary choice for 76.7% and 94.6% of Brazilian dermatologists, respectively.²¹

This high prescription rate of oral isotretinoin may be related to dermatologists’ recognition of its superior clinical efficacy compared with other acne treatments, promoting cure or prolonged remission, improving QoL, and reducing psychosocial damage, despite its mucocutaneous adverse events, such as cheilitis, and the risk of teratogenicity.³⁵ Additionally, dermatologists frequently prescribe topical and oral antibiotics, either alone or in combination, which contradicts published recommendations of limiting systemic antibiotics³³ and may contribute to bacterial resistance.²¹

In this survey, there was a notable absence of emphasis on dermocosmetics as monotherapy for patients with comedonal acne, with only 7% of Brazilian dermatologists recommending them despite evidence of efficacy.^21,35 Conversely, dermocosmetics were frequently prescribed across all acne severity levels, primarily as adjunctive therapy. However, their prescription declined as acne severity increased.²¹ These findings highlight the need to reassess treatment strategies and consider incorporating dermocosmetics more prominently in acne management protocols.^29,38,39

A recent study conducted at the Federal University of São Paulo/Brazil investigated the characteristics of acne in female employees over 25. Of the 241 participants, 96% reported inflammatory lesions. Severity was mild in 48.5%, moderate in 44.9%, and severe in 6.6%.⁴⁰ Research has shown that adult female acne (AFA) negatively impacts QoL, even with mild acne.^40,41 In this study, 68.7% had persistent acne, while 8.5% had late-onset acne. Skincare usage was similar for both types of AFA: sunscreen (50% vs 58%), moisturizers (30% vs 43%), and cleansers for oily skin (42% vs 47%). The use of oral isotretinoin was 22% in persistent acne and 13% in late-onset acne.⁴⁰ Surprisingly, oral antibiotics were overused (55% vs 41%), with lower usage of hormonal treatments like combined oral contraceptives (28% vs 26%) and spironolactone (11% vs 19%).^40,42

Recent Advances and Current Challenges in Acne Treatment

The new findings about the acne skin microbiome suggest a new approach to treatment that emphasizes microbiome rebalancing rather than antibiotic use.^8,43 In acne, the resident microbiome (commensal microbes living in homeostasis with the host) includes C. acnes and Staphylococcus epidermidis (S. epidermidis), while the transient microbiome (pathogens temporarily on the skin) includes Staphylococcus aureus (S. aureus).^8,43

Dysbiosis, an imbalance of the skin microbiome, has been implicated in acne inflammation.^43,44 Under normal conditions, the microbiome plays a key role in regulating immune defenses by releasing antimicrobial peptides and maintaining the skin’s protective barrier. When the skin barrier is disrupted, dysbiosis can occur, exacerbating acne symptoms. Acne is frequently associated with skin barrier alterations, including increased TEWL, changes in sebum composition, dysbiosis, and reduced ceramide levels.^8,43,44

C. acnes dominates the pilosebaceous unit and its proliferation has been widely associated with acne. However, the predominance of C. acnes in and around the pilosebaceous follicle does not adequately describe its role in acne. Acne is more prominently associated with a loss of diversity in C. acnes phylotypes and skin dysbiosis than with C. acnes proliferation.^8,43,45

It is known that the C. acnes population and other microbiota interact with the innate immune system, and the six different phylotypes of C. acnes exhibit differences in inflammatory potential and expression of virulence factors, leading with varying effects on innate immune system activation.⁸ Based on cellular morphology, inflammatory and immune-inductive properties, virulence factors and biochemical characteristics, C. acnes can be grouped into 3 phylotypes (I–III). By whole-genome sequencing, type I is subdivided into IA1, IA2, IB and IC and these phylotypes are related to acne.^8,46 Among these six phenotypes, the IA1 plays a predominant role in acne pathogenesis due to its capacity to form comedogenic biofilms and to induce T helper 17 cells (Th17) to produce inflammatory cytokines, such as interleukin 17 (IL-17). Therefore, dysbiosis in acne is characterized by a loss of phylotypic diversity of C. acnes, primarily due to the proliferation of a specific phylotype known as IA1. Sebum may play a role in promoting the growth of subtypes of C. acnes. Additionally, the sebaceous gland is a key factor in this interaction, as it can influence C. acnes to adopt a more virulent profile.⁸

Furthermore, S. epidermidis is believed to be an important player in the development of acne. It secretes sphingomyelinase to obtain nutrients, and this enzyme helps produce protective skin ceramides, contributing to skin barrier homeostasis.⁸ The balance between C. acnes and S. epidermidis is crucial to maintaining and regulating the homeostasis of the skin’s microbiota. S. epidermidis can inhibit the growth and proliferation of C. acnes and suppress the release of C. acnes-induced cytokines in keratinocytes, minimizing skin inflammation. Conversely, C. acnes can inhibit the development of S. epidermidis by controlling the pH of the pilosebaceous follicle. Both species affect monocyte survival, potentially playing a role in acne-associated hyperpigmentation.^8,45

A promising strategy for acne treatment involves the use of dermocosmetics to modulate the microbiome and preserve skin barrier integrity.^29,30,47

A study on oral isotretinoin therapy for acne conglobate found an increase in S. aureus colonization, particularly in the nose and face, due to skin dryness and inflammation. The treatment suppresses C. acnes, while promoting S. aureus growth. Prolonged C. acnes suppression after treatment may explain extended remissions.⁴⁸ To help counteract these changes, the use of dermocosmetic products is commonly recommended in clinical practice and expert consensus, including a soap-free or syndet cleanser able to maintain the physiological pH of the skin to ensure gentle and effective cleansing, and a moisturizer containing active ingredients to restore the skin barrier and microbiome.^30,47

Acne drug treatments, including topical benzoyl peroxide (BPO) and systemic antibiotics like minocycline and doxycycline, may induce dysbiosis by reducing microbial diversity in the skin.⁴⁴ To effectively manage acne, these treatments should be paired with suitable dermocosmetics to restore microbial homeostasis.^24,47 Prebiotic, probiotic, postbiotic, and microbiome-directed approaches are being investigated as potential strategies to support microbial balance and barrier function in acne, but clinical evidence remains heterogeneous.⁴⁴ Associating acne medications with appropriate dermocosmetics may help counteract dysbiosis and promote overall skin health.^44,47,49

Role and Practical Application of Dermocosmetics in Acne Management

Active Ingredients in Dermocosmetics and Acne Pathogenesis

Given acne’s multifactorial nature, dermocosmetics offer numerous opportunities to effectively address its key pathophysiological mechanisms, including excessive sebum production, hyperkeratinization, C. acnes dysbiosis, and inflammation - all of which contribute to the formation of microcomedones, the precursors of acne. Due to environmental factors and the high prevalence of darker skin phototypes in Brazil, the inclusion of depigmenting actions in the treatment regimen for acne patients is particularly relevant. The targeted actions of dermocosmetic ingredients within the pilosebaceous unit are illustrated in Figure 1.

Figure 1.

Active ingredients in dermocosmetics are designed to target specific skin concerns found in oily and acneic skin. (a) Targeting abnormal keratinization; (b) Targeting abnormal sebum production; (c). Protecting skin barrier, healthy microbiome balance and targeting C; (d) Targeting inflammation; (e) Preventing acne-induced hyperpigmentation.

Based on available evidence and data from an international consensus on the use of dermocosmetics in acne,³⁶ and following clinical practice, the authors agree on the benefit of dermocosmetics for patients with acne.³⁷ Although the scientific evidence for the use of dermocosmetics is less robust than that for acne medications, non-comedogenic and hypoallergenic dermocosmetic products, containing acne-target active ingredients, may be integrated into acne management as part of the daily treatment routine.^29,36,50

The main active ingredients used in dermocosmetics for acne management in Brazil are categorized according to their primary mechanism of action as keratolytic, sebum-controlling, anti-inflammatory, skin barrier and microbiome-protective, antimicrobial, and depigmenting agents.^{8,14,29,36,43,47,51–61} These categories and representative ingredients are summarized in Tables 1–6. These ingredients can be incorporated into the acne treatment and maintenance phases to enhance efficacy, minimize side effects, and prevent relapses.^{24,29,30,36,47,50} Understanding the specific mechanisms by which dermocosmetic ingredients affect acne pathogenesis may help physicians select appropriate treatment strategies and support the integration of these products into comprehensive skincare regimens. Improved tolerability, skin comfort, and patient satisfaction may also contribute to better treatment adherence and clinical outcomes.^24,27

Table 1.

Keratolytic Ingredients Used in Dermocosmetics for Acne Management

Active Ingredient	1Function/Mechanism and Evidence
Salicylic acid (SA)	Decreases lipogenesis and reduces inflammation by inhibiting NF-κB activation in sebocytes51
Lipo-hydroxy acid (LHA)	Induces desquamation, partly by breaking down superficial desmosomes that link corneocytes in the stratum corneum, and penetrates deeper into the sebaceous gland29,47
	Reduces the number of both inflammatory and non-inflammatory acne lesions29,47
Alpha hydroxy acid (AHA)	Thins the stratum corneum, increases epidermal thickness and dermal collagen synthesis29,47
	Prevents and reduces post-inflammatory hyperpigmentation when associated with depigmenting agents14
4-(2-Hydroxyethyl)-1-piperazine ethanesulfonic acid (HEPES)	Enhances the exfoliation of the stratum corneum, improving the penetration of other active ingredients36
Retinol and its derivatives	Increase epithelial turnover, promoting comedolytic action29,36
	Prevents and reduces post-inflammatory hyperpigmentation when associated do depigmenting agents14
Bakuchiol	Reduces inflammation and promotes skin cell turnover as it functions as a retinol analog, through retinol-like regulation of gene expression52

Table 2.

Sebum-Controlling Ingredients Used in Dermocosmetics for Acne Management

Active Ingredient	Function/Mechanism and Evidence
Niacinamide	Decreases sebum excretion rate in vivo29,36
Bakuchiol	Reduces and modulates 5α-reductase activity36,53
Bixa orellana seed extract	Reduces the size of active sebaceous glands36,53
Zinc compounds	Astringent and sebum-regulating properties55
Fullerene	Inhibits sebum production54
	Antioxidant properties54
Epigallocatechin-3-gallate (EGCG)	Reduces surface sebum level29,36,47
	Provides antioxidant protection29,36,47

Table 3.

Anti-Inflammatory Ingredients Used in Dermocosmetics for Acne Management

Active Ingredient	Function/Mechanism and Evidence
Bixa orellana seed extract	Antioxidant and anti-inflammatory properties53
Niacinamide	Modulates inflammatory cytokines29
	Reduces levels of pro-inflammatory mediators, inflammatory acne lesions and erythema36
Panthenol	Anti-inflammatory properties and high skin tolerability36,47
Bakuchiol	Anti-inflammatory properties36

Table 4.

Skin Barrier and Microbiome-Protective Ingredients Used in Dermocosmetics for Acne Management

Active Ingredient	Function/Mechanism and Evidence
High molecular weight Hyaluronic acid	Supports cell differentiation, wound healing, inflammation reduction, and skin hydration29
Niacinamide	Enhances skin barrier function and protects the microbiome by stabilizing the epidermal barrier36,47
	Reduces TEWL, helping to alleviate dryness and irritation from acne treatments36,47
Linoleic acid	Maintains epidermal water barrier integrity29,36,47
	Reduces microcomedo size29,36,47
Ceramides	Help restore the decreased levels characteristic of acne-prone skin, which compromise the skin barrier function, leading to dryness and potentially contributing to comedo formation56
2-oleamido-1,3-octadecanediol	Strengthens the skin barrier53
Thermal spring water	Enriches the diversity of skin microbiota with positive effects on skin barrier function8
Vitreoscilla filiformis-derived lysate (including Aqua Posae Filiformis)	Modulates inflammatory response, reduces substance P-induced inflammation, and strengthens the epidermal barrier36,57
Punica granatum pericarp extract	Inhibits C. acnes IA1 phylotype proliferation (in vitro), quorum sensing activity, and biofilm formation53
	Limits cells’ inflammatory responses53
Panthenol	Reduces TEWL and improve intercellular lipid content, improving skin barrier function and skin hydration47
Glycerin	Strengthens the epidermal barrier, reducing irritation and undesired effects associated with acne treatment29,36,47
Mannose	Strengthens the epidermal barrier, helping to alleviate irritation and other adverse effects linked to acne treatment29,36,47

Table 5.

Antimicrobial Ingredients Used in Dermocosmetics for Acne Management

Active Ingredient	Function/Mechanism and Evidence
Piroctone olamine	Antifungal action, reduces itching and inflammation36
Zinc compounds	Antimicrobial effects against C. acnes and S. epidermidis55
Tea tree oil	Anti-inflammatory and antimicrobial properties43

Table 6.

Depigmenting Ingredients Used in Dermocosmetics for Acne Management

Active Ingredient	Function/Mechanism and Evidence
Niacinamide	Reversibly blocks melanosome transfer from melanocytes to keratinocytes, preventing post-inflammatory hyperpigmentation58
2-oleamido-1,3-octadecanediol	Prevents the formation of hyperpigmentation; reduces redness associated with acne lesions8
2-mercaptonicotinoyl glycine (2-MNG)	Intercepts certain melanin precursors, dopaquinone, 5,6-dihydroxyindole (DHI), 5,6-dihydroxyindole-2-carboxylic acid (DHICA), without inhibiting tyrosinase activity59,60
Isobutylamido-thiazolyl-resorcinol	Inhibits tyrosinase and reduces melanin production61

Dermocosmetics may contribute to improved adherence to acne treatment, particularly by minimizing irritation, xerosis, and treatment-related discomfort.^24,27,29,30 However, patient engagement strategies and a strong doctor-patient relationship remain fundamental to optimize long-term adherence and treatment success. A robust doctor-patient relationship, characterized by approachability and motivation, is essential. When physicians actively understand and address patients’ barriers to adherence, such as fear of side effects or confusion regarding daily routine, they can foster an environment promoting compliance to prescribed regimens. Some supportive interventions include electronic messages, virtual engagements, audio-visual strategies or digital initiatives, and patient support programs, which may help improve treatment adherence.²⁴ This holistic approach not only improves adherence but ultimately also increases the overall effectiveness of the treatment.²⁴ For optimal outcomes, dermocosmetic products may be combined with adherence-enhancing interventions within acne management. Figure 2 outlines key recommendations.

Figure 2.

Expert recommendations for optimal outcomes in acne management.

The role of dermocosmetics in acne management can be summarized as follows: primary treatment for special patient groups (monotherapy); adjuvant therapy for a synergistic effect (targeting different mechanisms to enhance the efficacy of drug treatments or procedures); adjuvant therapy to manage side effects (alleviating treatment-related side effects and addressing potential skin barrier damage); and maintenance therapy (preventing lesion recurrence). Figure 3 presents a practical clinical algorithm for integrating dermocosmetics into acne management, highlighting the most important properties or target actions of the active ingredients found in products.

Figure 3.

Role of dermocosmetics in acne management. Algorithm illustrating the integration of dermocosmetics into acne treatment, informed by the experience of Brazilian dermatologists. Key properties of dermocosmetics active ingredients are highlighted according to their effect on acne pathophysiological pathways across different stages of disease management. The selection and use of specific dermocosmetic categories should be individualized according to patient characteristics, disease severity, skin sensitivity, and concomitant therapies. In patients receiving oral isotretinoin, keratolytic and sebum-controlling dermocosmetics should be used with caution and individualized according to tolerability, due to the potential for increased dryness and irritation.

Notes: ^aSide effects associated with oral isotretinoin. ^bWith restrictions and according to rational use principles. ^cAt low concentrations, when necessary. ^dTretinoin or adapalene. ^eAdapalene + benzoyl peroxide (preferred) or tretinoin + benzoyl peroxide. ^fHormonal treatment.

Dermocosmetic Monotherapy

Dermocosmetics may serve as an effective monotherapy treatment during the acute phase of acne, particularly for very mild and early forms of acne (comedonal, with hyper seborrhea; pre-pubertal).^18,30 The recommendations are supported by studies demonstrating an overall improvement in acne, reductions in inflammatory and non-inflammatory lesions, improvement in tolerability, reduction in skin oiliness, and additional positive effects on skin barrier function.³⁶

Dermocosmetics with keratolytic agents and niacinamide may be sufficient to control the disease.^18,29 For a better result, the dermocosmetic formula should ideally contain a mix of ingredients to attack the disease in different ways, allowing it to aid in sebum control, improve the keratinization process, reduce micro-inflammation, balance the skin microbiome, and protect the skin barrier function.²⁹ In a 56-day randomized, controlled trial (RCT) involving 150 patients with mild to moderate acne, a multitargeted dermocosmetic cream (containing salicylic acid (SA), lipo-hydroxy acid (LHA), niacinamide, 2-oleamido-1,3-octadecanediol, Zn PCA, lysate of Vitreoscilla filiformis, and thermal spring water) was compared to 5% BPO gel, both applied twice daily. Results showed that the dermocosmetic achieved better global assessment improvements (Global Evaluation of Acne grading system response rate: 47.3% vs 36.5% for BPO) and was better tolerated. Both treatments significantly reduced inflammatory, non-inflammatory, and total lesion counts with comparable efficacy.⁶²

Adjunctive Therapy

Acne management is based not only on the use of specific drugs, but also on complementary dermocosmetic products, such as face creams specifically formulated to treat acne, moisturizers, cleansers, and sunscreens.^47,63 All these products have gained increasing importance in the last years and they can target additional pathogenic factors as an adjunctive to a drug treatment (synergistic effect) or they can alleviate side effects of acne medications.^24,29,47

Dermocosmetics could provide a synergistic effect by targeting additional key pathogenic factors and improving the efficacy of treatments prescribed for acne.^24,29,47 They can be used in alternation or associated to topical medication in acne to improve the tolerance/efficacy ratio, particularly when the topical drug is recommended to be used every-other-night to minimize side effects.^24,29 The combined use of a dermocosmetic (containing niacinamide, LHA, SA, linoleic acid and piroctone olamine), 30 minutes before 5% BPO in treating mild-to-moderate acne showed the highest rate of skin lesion clearance after 56 days of treatment when compared to the individual use of either product.⁶⁴

The management of side effects in acne treatment involves addressing skin irritation associated with topical or systemic acne medications, resulting in a lack of patient adherence.²⁶ BPO increases TEWL, damages skin antioxidants and can induce lipid peroxidation.⁶⁵ Topical retinoids initially cause erythema and fine desquamation.⁶⁶ Oral isotretinoin, which is the most effective medication for acne, usually causes dry skin and cheilitis.^35,66 Dryness or skin irritation may cause barrier disruption of the stratum corneum and inflammation. Thus, moisturizers containing anti-inflammatory agents and ingredients to protect skin barrier and microbiome are recommended as adjunctive treatments.^24,29,47 Pre-application and simultaneous use of a barrier-enhancing moisturizer with topical retinoid facilitated adaptation to retinoid-induced skin irritation, reducing TEWL, and enhancing skin hydration.^29,66

Dermocosmetic cleansers containing SA or other keratolytic agents are recommended for acne patients, as they aid in eliminating follicular plugs and preventing obstruction.^63,66 Aggressive cleansing or using a cleanser with unsuitable pH can worsen acne.^29,47 Products with a physiological skin pH are less irritating and may enhance treatment adherence. Alkaline soaps can disrupt the skin barrier repair mechanism, leading to irritation and increased TEWL.^47,63,67 It is important to select a suitable facial and body cleanser, preferably soap-free or containing synthetic detergent (syndet) products, for all acne patients.⁴⁷ A deep cleansing gel (containing 2% SA, zinc gluconate and LHA) significantly reduced the number of mild to moderate truncal acne lesions and improved the skin barrier by reducing TEWL.⁶⁵ The same dermocosmetic cleanser was used twice daily, as monotherapy for 28 days to manage mild to moderate facial acne, resulting in significant improvement along with an excellent tolerance profile on the face.⁶⁸ Cleansing agents suitable for oily and sensitive skin, with sebum controlling ingredients, are preferred for acne management.¹⁸ The optimal cleansing frequency is twice daily using gentle techniques.⁶³ Excessive use or scrubbing of affected areas should be avoided to prevent dryness and skin inflammation.^25,47

Photoprotection against Ultraviolet A radiation (UVA), Ultraviolet B radiation (UVB) and visible light (VL) is recommended for acne patients, with SPF ≥ 30 and a vehicle suitable for acne patients and their treatments. The need for UV protection is increased during acne treatments, such as BPO or retinoids, as the skin barrier integrity is reduced, leading to exacerbated photosensitivity.⁴⁷ Sunscreen can also help prevent PAH in acne patients, as post-inflammatory hyperpigmentation may be increased by chronic and intense solar exposure, a significant issue in Latin America. Evidence indicates a synergistic effect of both UVA and VL in post-inflammatory hyperpigmentation development, especially for those with higher levels of skin pigmentation.^12,13 Tinted sunscreens can protect against UVA and VL very efficiently and provide camouflage. Camouflage and corrective makeup, particularly oil-free and non-greasy formulations, can boost self-esteem and improve quality of life while minimizing lesion manipulation and providing photoprotection.^18,42,63 Rigorous photoprotection should also be recommended following in-office procedures such as chemical peelings and lasers.^18,29

Maintenance Therapy

Acne lesions often recur, necessitating a sustained remission strategy comprising an initial attack phase followed by maintenance. The maintenance phase is the treatment regimen to maintain the response achieved by the initial approach. Multifunctional dermocosmetics may support long-term adherence during maintenance therapy.^1,29,42

Specifically in the adult female population, long-term maintenance is essential because recurrences are common.^41,42,69 Dermocosmetics may contribute to maintaining clinical improvement and preventing new lesion formation, while also targeting specific aspects of acne pathogenesis and preventing PAH.²⁹

The recommendations are supported by two RCTs and other studies that investigated the use of dermocosmetics to maintain acne clearance after medical therapy.³⁶ In one study, 50 patients who achieved significant acne improvement with 0.1% adapalene /2.5% BPO gel, underwent a double-blinded, split-face, maintenance phase (12 weeks), comparing a dermocosmetic (containing licochalcone A, 1,2-decanediol, L-carnitine, and SA) and the vehicle, applied twice daily. Results showed significantly fewer acne lesions on the dermocosmetic-treated side compared to the vehicle side.⁷⁰ In another RCT, acne patients previously treated with either BPO + vehicle or BPO + dermocosmetic (containing niacinamide, LHA, SA, linoleic acid, and thermal spring water) over 12 weeks, were later randomized during the maintenance phase. They either continued with the dermocosmetic or received a placebo for an additional 12 weeks, with 50 patients in each group. During this phase, acne lesions continued to decline in patients using the dermocosmetic. In contrast, patients randomized to the placebo experienced acne relapses and related symptoms approximately 6 weeks after stopping BPO.⁷¹ These results are consistent with the authors’ clinical experience, particularly regarding the importance of maintenance strategies to reduce relapses and support long-term adherence.

Dermocosmetics for Special Groups of Patients

Due to their high safety profile, good tolerability, and ability to restore skin barrier function, the role of dermocosmetics among specific populations, such as women trying to conceive, pregnant and breastfeeding, is increasing. Dermocosmetics developed to treat acne skin can be useful as maintenance therapy and may represent safe options during pregnancy and lactation.²⁹ Cleansers containing sebum controlling agents and photoprotection can be included in the daily routine.^29,66

Pre-pubertal patients are a large group who tend to have mild acne at an early age. Pre-pubertal acne may be managed with mild and good cleansers and an anti-acne dermocosmetic containing ingredients such as SA and niacinamide.¹⁸ Appropriate follow-up is necessary, and it can help dermatologists to identify possible acne progress to adjust treatments and promote a trusting relationship with the patient and parents.

Oily skin, which is characterized by a high amount of sebum, especially on the face region, presents undesirable clinical signs to patients, such as excessive brightness, enlarged pores, and acne, requiring special care. This condition can persist throughout life and can negatively impact the quality of life.³⁶ Studies show a direct relationship between pore size and sebaceous gland activity.^72,73 A study aimed at characterizing Brazilian oily skin noted an imbalance in the skin’s hydro-lipidic mantle, which plays a crucial role in maintaining the skin barrier’s integrity, transporting antioxidants, and exerting antimicrobial and anti-inflammatory activities. The results demonstrated no correlation between increased oiliness and skin hydration in adult women, debunking the misconception that oily skin is necessarily well-hydrated.⁷² Multifunctional dermocosmetics containing sebum-controlling agents, moisturizers and keratolytic ingredients can improve skin structure and reduce the clinical signs related to excessive oiliness.^36,72

Expert Recommendations/Practical Considerations to Improve Adherence

Dermocosmetics should be considered part of the daily routine in acne management, particularly during therapeutic intervention and maintenance phases. They may benefit acne-prone patients, especially because many acne treatments can compromise the skin barrier. Dermocosmetics may improve adherence by reducing treatment-related irritation, xerosis, and discomfort, while improving cosmetic acceptability and patients’ perception of skin tolerability. Nevertheless, dermocosmetic formulations are heterogeneous, and the level of evidence varies considerably across products and active ingredients. In addition, inappropriate comedogenic or irritating products may worsen skin condition and negatively affect treatment adherence. Therefore, dermatologist-guided selection of dermocosmetics may contribute to improved adherence and overall clinical outcomes in acne management.^12,24,66

Final Considerations

Dermocosmetics play an important role in acne management, contributing to improved tolerability, skin barrier support, clinical outcomes, and patient adherence.^24,26,28 These products, designed for patients with acne, generally have favorable safety and tolerability profiles.²⁴ Incorporating dermocosmetics into daily skincare routines, including multi-target antiacne products, moisturizers, cleansers, and sunscreens, may help reduce both inflammatory and non-inflammatory lesions, especially when combined with drug treatments.^29,30,47

A tailored approach remains fundamental in acne care, with dermatologists selecting dermocosmetic products based on the patient’s skin type, acne severity, treatment phase, tolerability, and history of previous therapies.^13,15,21,73 In adult women with acne, dermocosmetics may also help avoid inappropriate skincare practices and reduce anxiety until clinical improvement is observed.⁷⁴ Balancing therapeutic actives with supportive dermocosmetic strategies and educating patients about continuous skincare routines may help prevent or alleviate irritation, inflammation, and xerosis - common issues that often lead to poor treatment adherence.^24,29,63 By preparing patients for potential initial inefficacy or transient exacerbation during the early phases of treatment, dermatologists can foster realistic expectations and improve long-term satisfaction.^12,15

Overall, this review highlights the important role of dermocosmetics in acne management, both as monotherapy in selected cases of mild acne and as adjunctive care to medical treatments to improve tolerability, support adherence, and minimize treatment-related adverse skin effects, including during the maintenance phase. Given the diversity of the Brazilian population, skin phototypes, climate, and risk of post-inflammatory hyperpigmentation, practical and population-specific recommendations remain clinically relevant. However, despite increasing evidence supporting the integration of dermocosmetics into acne care, available studies remain heterogeneous regarding formulations, study designs, outcomes, and levels of evidence. Further studies are encouraged to strengthen evidence-based guidance regarding the optimal use of dermocosmetics in patients with acne, particularly in the Brazilian population.

Funding Statement

This work was supported by L’Oréal Brazil, which funded the expert group meeting and the open access publication fees. The sponsor had no role in the content development, analysis, interpretation of the literature, or final approval of the manuscript, which reflects the independent opinions of the authors.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

Marco Alexandre Da Rocha has served as advisor/consultant for La Roche-Posay, Eucerin, Galderma, Hypera, Bioderma, and Kenvue. Prof Ediléia Bagatin has served as advisor, speaker, and consultant for L’Oréal (La Roche-Posay, Vichy, and CeraVe), Pierre Fabre, USK, Leo Pharma, Farmoquímica, and Eurofarma. Prof Brigitte Dréno has served as consultant for Galderma, Almirall, Pierre Fabre, La Roche-Posay, NAOS, Bristol Myers Squibb, Huvy IA, Biofortis, and Sanofi, and is a member of the Scientific Advisory Board of Deuxième Avis. Dr Gabriel Gontijo has served as consultant for La Roche-Posay. Dr Beatriz Medeiros Ribeiro has served as advisor/consultant for L’Oréal (La Roche-Posay and CeraVe) and Eucerin. Prof Luiz Mauricio Almeida has served as advisor, speaker, and consultant for L’Oréal (La Roche-Posay, Vichy, and CeraVe), Pierre Fabre, USK, Galderma, and Beiersdorf. The authors declare no other conflicts of interest related to this work.