This review of current acne treatments begins with the crucial discovery in 1979 of isotretinoin treatment for nodulocystic acne. This drug s approval in 1982 revolutionized therapy, since it was the first oral acne-specific drug, and it provided prolonged remissions. In addition, it may prevent the emergence of resistant bacteria, a problem linked to the traditional use of antibiotics for acne. Patients who are not candidates for isotretinoin therapy may benefit from one of the other drugs or drug combinations reviewed, including the third-generation topical retinoids adapalene and tazarotene, retinoic acid reformulated in new vehicles, azelaic acid, and topical antibiotics. Proper selection and education of patients are essential, since serious consequences may result from poorly monitored use of antibiotics and retinoid.