Acne: Systemic treatment

Acne vulgaris is a disease affecting mostly adolescents and young adults that, when severe, has the potential to result in scarring and permanent disfigurement. Systemic treatment is necessary to prevent significant psychological and social impairment in these patients. Significant inflammatory and nodulocystic acne is usually recalcitrant to topical treatment, whereas uncommon acne variants, such as acne fulminans, pyoderma faciale, and acne conglobata, need to be promptly and effectively controlled. In all of these circumstances, systemic agents are indispensable. The choices include oral antibiotics, isotretinoin, and hormonal treatment (Table 1).