There is still fertile ground for investigation. Patients in their 30s still have high levels of P acnes , lots of sebum, and significant numbers of microcomedones, yet significant acne is uncommon, even in those who had severe involvement as teenagers. The link between acne and rosacea is still obscure. It is clear to most clinicians that the condition of some fair-skinned patients evolves from acne into rosacea when these patients are in their 20s. The interaction between vascular reactivity and the sebaceous gland in producing rosacea is also a mystery.
Therapeutic challenges remain as well.
We lack a safe topical sebaceous gland inhibitor, and there is no oral sebostatic that does not carry significant risk to the unborn. On a more mundane level, the number of topical medications needed to adequately control acne vulgaris in most patients is a matter of some controversy. Although not scientifically sexy, acne is a disease that affects billions of people and costs as much to treat. Money spent on its investigation is well spent both in a human and an economic sense. Thiboutot D, Gilliland K, Light J, Lookingbill D. Androgen metabolism in sebaceous glands from subjects with and without acne.