Forty-eight acne patients were treated orally with 13-cis-retinoic acid in a double-blind dose response study. There was a marked clinical improvement with a concomitant reduction in sebum excretion rate (SER) and production rate of free fatty acids (FFA). Microbial numbers decreased significantly; the decrease in propionibacteria was greater than that of aerobic bacteria. The decline in micro-organisms occurred after the reduction in sebum and FFA production. This suggests that the effect of the drug upon micro-organisms is secondary to the change in sebum excretion but it is nevertheless an important factor in the resolution of the acne.