Acne is a chronic inflammatory skin disease concerning the sebaceous glands with a prevalence of 70-87%, and has more psychological and social effects on adolescents than asthma or epilepsy. Treatment options for acne vary tremendously among dermatologists. Some treatments lack support in the literature, and some are even harmful to patients, society, and the patient’s economy. At the same time, it is essential to have a set of practical guidelines to regulate the treatment of physicians who work in dermatology clinics but have no formal training in dermatology specialties. Of course, guidelines are not set in stone and need to be updated periodically as new evidence-based medicine and new drugs become available. Topical treatment of acne】 Topical washing: Care should be taken to wash the face with water to remove oil and a mixture of dander and bacteria from the skin surface. However, excessive washing should not be done. Do not squeeze or scratch the acne with your hands. In addition, avoid using oil and grease, powder skin care cosmetics and ointments and creams containing hormonal ingredients. Antibiotic treatment for acne] Oral antibiotics are one of the effective methods for treating acne, especially moderate to severe acne. Among the many colonizing microorganisms (including Staphylococcus epidermidis, Propionibacterium acnes, Malassezia furfur and other gram-negative bacilli), only live Propionibacterium acnes is clearly and closely associated with an aggravated inflammatory response to acne, so choosing antibiotics that are sensitive to Propionibacterium acnes is an important starting point. In addition to infection-induced inflammation, immune and nonspecific inflammatory responses are also involved in the formation of inflammatory damage in acne, so antibiotics that can both inhibit Propionibacterium acnes reproduction and take into account nonspecific anti-inflammatory effects should be given priority. Combining the above factors with the pharmacokinetics of antibiotics, especially selective distribution at the seborrheic site, tetracyclines should be preferred, followed by macrolides, others such as cotrimoxazole and and metronidazole can also be used as appropriate, but lactam antibiotics should not be chosen. Among the tetracyclines, the first generation tetracyclines such as tetracycline are poorly absorbed orally and have low sensitivity to Propionibacterium acnes. Second generation tetracyclines such as minocycline, doxycycline and lymetetracycline should be preferred, and the two should not be substituted for each other. For systemic infections currently the main or commonly used antibiotics such as clarithromycin, roxithromycin and levofloxacin are avoided. Since an important basis for effective antibiotic treatment of acne is the inhibition of Propionibacterium acnes reproduction, rather than a non-specific anti-inflammatory effect, it is important to prevent or slow down the development of drug resistance in Propionibacterium acnes, which requires the standardization of drug dosage and regimen. Acne treatment with retinoic acid] Oral isotretinoin is the standard treatment for severe acne and is currently the most effective treatment for acne. Isotretinoin acts on all pathophysiological aspects of acne pathogenesis, and although the therapeutic effect is significant, it is not used as the first choice of treatment for mild acne as much as possible, considering its side effects. Under certain conditions, such as adolescents with severe acne, continuous low-dose isotretinoin can be used for treatment. In these patients, acne dissolution is poor in the initial stages, but a 4-6 month course of 10-20 mg/d of isotretinoin can clear the rash more quickly, followed by topical retinoic acid to maintain efficacy. Hormone therapy for acne】 Application of estrogens and anti-androgenic drugs 1. Estrogens Estrogens include two major categories: estrogen and progestin. It is currently believed that androgens play a role in the development of acne. Female patients with moderate or severe acne should be treated with estrogen and progestin early if they also have high androgen levels and signs of high androgen activity (seborrhea, acne, hirsutism, androgenic alopecia: abbreviated as (SAHA)) or the presence of polycystic ovary syndrome (PCO). Combined use of birth control pills may also be considered in female patients with late-onset acne and those whose acne worsens significantly before menstruation. The FDA has approved the use of birth control pills for the treatment of acne in women over the age of 15. Chinese medicine treatment for acne】 Chinese medicine treatment should be divided into different types of treatment and added or subtracted according to the symptoms. The treatment of red papular acne is recommended to clear the lungs and stomach; the treatment of pustular acne is recommended to detoxify and disperse nodules; the treatment of premenstrual acne is recommended to regulate the flushing method; and the treatment of aggregated acne, post-pigmentation or scarring is recommended to activate blood circulation and disperse stasis.