The 2025 update by Saurat and Oulès redefines acne management by focusing on the microcomedone as the subclinical origin of the disease.

• The "Egg" Concept: The microcomedone is not an "inert plug" but "an egg" from which all visible acne lesions develop. While visible lesions are few, up to 30% of non-lesional skin may contain these subclinical precursors.
• The Comedo Switch: This is the initial step in acne pathogenesis where LRIG1+ stem cells in the pilosebaceous unit shift from producing healthy epithelium to a hyper-keratinized, less functional state.
• GATA6 Regulation: The transcription factor GATA6 is the master regulator of this process. High levels maintain homeostasis, while reduced expression triggers the "switch" toward microcomedone formation.
• A New Strategic Target: The primary goal of long-term acne therapy should be maintaining homeostasis in non-lesional skin to prevent the comedo switch. Treating visible papules and pustules is now considered a "secondary preventable target".
• Monitoring Success: Tools like Cyanoacrylate Skin Surface Stripping (CSSS) allow clinicians to calculate a "microcomedone index," which serves as a predictor of future outbreaks and a marker for clinical remission.