From salves to Sulzberger: the emergence of the American approach to acne treatment
Historical review published in Clin Dermatol (2025)
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.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Historical review of American acne-treatment evolution including bloodletting/leech historical context.
Why This Matters for Hirudotherapy
This historical review traces the evolution of acne treatment in the United States, cataloguing therapeutic milestones from early humoral-theory-based interventions through modern evidence-based approaches including isotretinoin. The abstract notes that early approaches worldwide included bloodletting alongside arsenicals, sulfur preparations, and folk remedies. This passing mention of bloodletting may be of tangential interest to ASH, given the historical association between bloodletting practices and leech therapy, though the article makes no reference to leeches or hirudotherapy. Relevance to ASH's domain is minimal; the review's focus is the broader cultural and scientific transition in dermatologic care, and bloodletting appears only as one of several discarded historical interventions.
Citation
From salves to Sulzberger: the emergence of the American approach to acne treatment.
Wozna et al. · Clinics in dermatology, 2025
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