Acne vulgaris, which occurs in 50 million persons living in the United States, is associated with physical and psychological morbidity e. In addition, knowledge about its pathogenesis is constantly evolving. First-line treatment for mild acne vulgaris includes benzoyl peroxide or a topical retinoid, or a combination of topical medications consisting of benzoyl peroxide and an antibiotic erythromycin or clindamycin , retinoid, or both. An alternative treatment would include the addition of a topical retinoid or benzoyl peroxide if not already prescribed; a different retinoid; or topical dapsone Aczone. First-line treatment for moderate acne vulgaris includes a combination of benzoyl peroxide and a topical antibiotic erythromycin or clindamycin , topical retinoid, or both; benzoyl peroxide, an oral antibiotic, and topical retinoid; or benzoyl peroxide, oral and topical antibiotics, and a topical retinoid. Alternative treatments to be considered include a different combination of medications; changing the oral antibiotic; adding a combined oral contraceptive or spironolactone in females; or oral isotretinoin.