Topical Hypochlorous Acid for Acne Vulgaris: Mechanisms, Clinical Evidence, and Therapeutic Potential.

Acne vulgaris is driven by Cutibacterium acnes, sebaceous activity, and innate immune activation, leading to inflammation, scarring, and reduced quality of life. Although standard topical and systemic therapies are effective, their use may be limited by irritation, adverse effects, and antimicrobial resistance. Hypochlorous acid (HOCl) exhibits antimicrobial, biofilm-disruptive, and anti-inflammatory activity through inhibition of nuclear factor kappa B (NF-κB) and mitogen-activated protein kinase (MAPK) signaling. Preliminary studies suggest HOCl provides lesion reductions comparable to benzoyl peroxide with superior tolerability and no barrier disruption, supporting its potential as an adjunctive acne therapy pending larger controlled trials.