The development of scarring in inflammatory acne may induce permanent disfigurement and considerable psychosocial impact on the lives of affected individuals. The early use of systemic acne therapy can help to prevent these unfortunate consequences. Antiinflammatory antibiotics such as tetracyclines are required in moderate to severe papulopustular acne. The recommended treatment duration is 3 months; combination with topical retinoids and benzoyl peroxide increases the speed and efficacy of lesion reduction and helps to prevent bacterial resistance. Oral isotretinoin is the treatment of choice in severe acne resistant to adequate conventional therapy. Hormonal treatment represents an alternative regimen for women with acne and is the first choice in late-onset acne and in those with clinical signs of hyperandrogenism.