Maintenance therapy for acne vulgaris: the fine balance between efficacy, cutaneous tolerability, and adherence.

Maintenance therapy is defined as the regular use of appropriate therapeutic agents to ensure that acne remains in remission. Topical agents are the mainstay of maintenance therapy. A number of topical therapeutic options are available, including topical retinoids, benzoyl peroxide, and azelaic acid. The choice of topical agents should be based on a number of criteria: efficacy in addressing the subclinical microcomedo, which is the precursor lesion for both comedones and inflammatory lesions; tolerability, due to the need for application to a broader epidermal surface; and other properties that may enhance adherence. Patients may be more motivated to use agents that are easily integrated into their lifestyles and that have potential "skin-repairing" properties.