Acne Skin is a common skin disease that affects most people at some time during their lives. It is characterized by mild acne known as blackheads and whiteheads, semi-severe inflammation acne called papules and pustules, or severe acne known as nodules and cysts. Acne affects the areas of skin with the densest population of oil (or sebum) producing gland called sebaceous gland. The exact underlying causes of acne are not yet fully understood. However, in general, there are three recognized factors for the development of an acne lesion. These factors are: Overgrowth of sebaceous gland called follicular epidermal hyperproliferation; Excess sebum production; Presence of bacteria called P. acne. There are three factors that may independently initiate follicular epidermal hyperproliferation, including excessive production or hypersensitivity to male hormones called androgens, secretion of inflammatory biochemical signals such as IL-1α, and/or decreased content of linoleic acid in sebum. Sebum production is regulated by a number of hormones such as androgens, insulin-like growth factor, growth hormone, and vitamin D3. Increased levels of and/or increased sensitivity to androgens, insulin-like growth factor, growth hormone, and inflammatory signals are thought to cause acne. IL-1α is an inflammation-inducing signal involved in our body’s immune defense against infection. IL-alpha, when administered in skin tissue, causes follicular epidermal hyperproliferation leading to acne. Any low-grade inflammation, such as food sensitivity and mild dysbiosis in gut may cause acne via systemic release of IL-1α. Change in composition of sebum is known to occur prior to onset of acne, notably a decrease in linoleic acid content. Clinical studies have demonstrated that successful retinoid therapy normalizes linoleic acid content in sebum. Traditionally dermatologists believed that there is no causative relationship between diet and acne. Very recently, however, several clinical studies suggest that diet may change composition of sebum (oil) and may reduce the number of acne lesions. P. acne is normal bacteria that is found on healthy skin. It only causes acne when pores are occluded by sebaceous plug. Therefore antibiotic therapy targeting P acne alone is often not long lasting. Acne appears to be a result of the web-like, interconnected nature of physiologic processes, diet, and lifestyle, requiring an integrated therapeutic approach in order to attain the desired clinical results. A successful treatment should address all involved factors. Our acne treatment programs have been tremendously successful, effectively treating from blackhead to severe inflammatory acne lesions, often without oral medications.