This review explores the pathophysiology of acne and current and emerging treatment strategies. Acne vulgaris, the most common form of acne, affects individuals of all ages, particularly adolescents and young adults. It is characterized by non-inflammatory (blackheads, whiteheads) and inflammatory (papules, pustules, nodules, cysts) lesions. The condition arises from a complex interplay of genetic, hormonal, microbial, and inflammatory factors, including sebaceous gland hyperactivity, follicular hyperkeratinization, and microbial colonization by Cutibacterium acnes. Current treatment strategies include topical agents such as retinoids, benzoyl peroxide, and antibiotics, as well as systemic therapies like oral antibiotics, hormonal treatments, and isotretinoin. Procedural treatments, including laser devices and chemical peels, and dietary modifications are also considered. Emerging therapies focus on novel biologics, bacteriophages, probiotics, and peptides. Topical retinoids, such as tretinoin, adapalene, tazarotene, and trifarotene, are effective in reducing comedones and inflammation. Benzoyl peroxide is a first-line antimicrobial treatment, while topical antibiotics like clindamycin and erythromycin are used for their anti-inflammatory and antibacterial effects. Azelaic acid, salicylic acid, and dapsone are also used in acne treatment. Clascoterone, a novel topical antiandrogen, is effective in reducing sebum production and inflammation. Systemic treatments include oral antibiotics, hormonal therapies (such as combined oral contraceptives and spironolactone), and isotretinoin for severe cases. Hormonal therapies are particularly effective in women with acne related to hormonal fluctuations or conditions like polycystic ovary syndrome. Isotretinoin is highly effective but requires careful monitoring due to its teratogenic effects and potential side effects. Emerging therapies, including biologics, bacteriophages, and probiotics, offer promising future options for acne treatment. The review emphasizes the importance of personalized treatment approaches due to the multifaceted nature of acne and highlights the potential of innovative therapies to improve patient outcomes.This review explores the pathophysiology of acne and current and emerging treatment strategies. Acne vulgaris, the most common form of acne, affects individuals of all ages, particularly adolescents and young adults. It is characterized by non-inflammatory (blackheads, whiteheads) and inflammatory (papules, pustules, nodules, cysts) lesions. The condition arises from a complex interplay of genetic, hormonal, microbial, and inflammatory factors, including sebaceous gland hyperactivity, follicular hyperkeratinization, and microbial colonization by Cutibacterium acnes. Current treatment strategies include topical agents such as retinoids, benzoyl peroxide, and antibiotics, as well as systemic therapies like oral antibiotics, hormonal treatments, and isotretinoin. Procedural treatments, including laser devices and chemical peels, and dietary modifications are also considered. Emerging therapies focus on novel biologics, bacteriophages, probiotics, and peptides. Topical retinoids, such as tretinoin, adapalene, tazarotene, and trifarotene, are effective in reducing comedones and inflammation. Benzoyl peroxide is a first-line antimicrobial treatment, while topical antibiotics like clindamycin and erythromycin are used for their anti-inflammatory and antibacterial effects. Azelaic acid, salicylic acid, and dapsone are also used in acne treatment. Clascoterone, a novel topical antiandrogen, is effective in reducing sebum production and inflammation. Systemic treatments include oral antibiotics, hormonal therapies (such as combined oral contraceptives and spironolactone), and isotretinoin for severe cases. Hormonal therapies are particularly effective in women with acne related to hormonal fluctuations or conditions like polycystic ovary syndrome. Isotretinoin is highly effective but requires careful monitoring due to its teratogenic effects and potential side effects. Emerging therapies, including biologics, bacteriophages, and probiotics, offer promising future options for acne treatment. The review emphasizes the importance of personalized treatment approaches due to the multifaceted nature of acne and highlights the potential of innovative therapies to improve patient outcomes.