Charles often prescribes isotretinoin, an oral medication commonly known as Accutane (though that brand is no longer distributed) that falls under a class of treatments called retinoids. It’s one of the best available treatments for acne. But it’s far from perfect: It can be incredibly drying, and risks causing such severe birth defects that female patients who take it are required to prove that they’re on two forms of birth control or abstaining from sex with men.

The scorched-earth acne solution

“Accutane is my bread and butter,” Charles says. “But it has to be administered carefully, preferably by a board-certified dermatologist.”

Adelaide Hebert, a professor of dermatology at McGovern Medical School at UTHealth in Houston, says providers sometimes prescribe the blood-pressure-regulating drug spironolactone to treat acne. And dermatologists often recommend less invasive (and often less effective) methods such as topical retinoids, antibiotics, birth control, and over-the-counter products with salicylic acid or benzoyl peroxide. Most of these treatments target just one potential cause of acne: For bacterial acne, there’s antibiotics. For hormonal acne, there’s birth control. Few address both, along with the myriad other factors, from pore-clogging makeup to time spent wearing a helmet, that contribute to acne.

While the acne vaccine in development is, according to Charles, “really promising,” it, too, has a narrow focus: the inflammatory response to skin bacteria. Emmanuel Contassot, a senior assistant at the University Hospital and Faculty of Medicine of the University of Zurich and the author of a commentary responding to the vaccine research, says that there’s reason to be hopeful regarding the new vaccine, but that it will potentially come with side effects of its own. “Targeting P. acnes [the bacteria most often associated with acne] with a vaccine would be more specific and less toxic than chemical therapies,” he says. But not all P. acnes bacteria is bad, he notes; it’s made up of different strains, and while some cause acne, others are beneficial. If it targets the wrong strains, the vaccine “might worsen patients’ condition by disturbing skin integrity,” Contassot says.

Charles says he imagines the vaccine would be best employed alongside other, more established acne treatments. “I wouldn’t envision it being a single agent, but it may help to pare down some of the other things that we do,” he says.

Other emergent acne therapies have also shown promising results in the past couple of decades. One such method uses probiotics, which, according to Jennifer Chwalek, a dermatologist at Union Square Laser Dermatology, may help lessen acne in some patients. “One of the most interesting ideas is targeting the gut/skin microbiome dysfunction,” she says. Some studies have found that applying a particular bacterium may have anti-inflammatory and bacteria-killing effects.