Acne affects more than 85% of teenagers in the United States and often continues into adulthood. The most deleterious form can result in permanent scarring on the face, chest, and back. Although the pathogenic features of acne are well known, the initiating factor remains unknown. Isotretinoin is effective against all of the pathogenic features of acne but is contraindicated in pregnant women and has been associated with elevations in triglyceride levels. Combination regimens appear to be effective, but physicians should avoid prescribing complicated treatment regimens. Hormone therapy has been found to improve acne in some women and should be considered in appropriate candidates. Although the list of available and effective agents appears to be extensive, several are contraindicated in pregnant women, and long-term use of antibiotics to target inflammation has been linked to agranulocytosis and Stevens-Johnson syndrome. Further investigation into agents that can reduce sebum production is warranted.