From Salves to Sulzberger: The emergence of the American approach to acne treatment

Abstract

Acne vulgaris is the most prevalent chronic skin disorder in the United States, affecting approximately 50 million individuals annually. Despite the availability of effective modern therapies, the evolution of acne treatment remains a rich and understudied topic in dermatologic history. This review traces the historic progression of acne management in the United States, highlighting key therapeutic milestones, shifts in clinical practice, and evolving societal perceptions of the disease. Early approaches to acne worldwide, rooted in humoral theory, included arsenicals, bloodletting, sulfur preparations, and folk remedies. The late 19th and early 20th centuries saw a gradual move toward rational therapies, including dietary regulation, topical antiseptics, and even vaccine and x-ray treatments. By the mid-20th century, dermatology entered a scientific era led by figures such as Dr Marion B. Sulzberger, ushering in antibiotic therapy, keratolytics, and eventually isotretinoin, representing the first treatment to target all major pathogenic factors. This period also marked a cultural shift: acne was no longer seen as a trivial esthetic issue but a condition with significant psychologic implications. The history of acne therapy in the United States illustrates a transition from empiric and often harmful interventions toward evidence-based, patient-centered care. Although treatments have advanced significantly, enduring challenges remain, particularly in addressing the psychologic burden of the disease. Continued innovation, both pharmacologic and psychosocial, is essential to meet the complex needs of acne patients today.