In rare circumstances anti-androgenic medications could be administered. Today is the using oral isotretinoins Forth type of treatment, which are authorized in serious nodulocystic acne. Isotretinoin could also be used in moderate to serious acne vulgaris when typical therapy fails. Pre-treatment counseling with a skin doctor is very important because of the many possible unwanted effects. Patient selection and monitoring are critical because of the possible adverse psychiatric occasions. Each female individual should undergo pregnancy check before commencing treatment to eliminate the possibility of being pregnant, for isotretinoin can be teratogenic to the fetus and will cause serious congenital defects.