Acne vulgaris is a chronic inflammatory disease of multifactorial etiology that affects the pilosebaceal unit. The characteristic period for onset of acne is adolescence with increasing persistence or the appearance of acne in adulthood. The clinical presentation of acne can vary from mild to severe, characterized by a variety of lesions that include comedones, papules, pustules and nodules, scarring and dispigmentation. The etiopathogenesis of acne is complex and involves the interaction of endogenous and exogenous factors. The main pathogenetic mechanisms take place in the pilosebaceal unit and include increased production and altered lipid composition of sebum, hyperkeratinization, reproduction of Cutibacterium acnes bacteria and inflammation. In addition to these factors, today attention is focused on other etiological factors that may contribute to the development of acne, and include diet, stress, the connection of intestinal microflora, brain and skin, sun exposure, premenstrual acne, comedogenic cosmetics and smoking. Given the diversity of etiological factors and the complexity of pathogenesis, finding a single cure with satisfactory effects and good tolerability is not easy. Acne, due to its characteristic clinical features involving the face and causing sometimes permanent scarring, if untreated can lead to negative psychosocial consequences on the individual. Therefore, it is of extreme importance to have a good understanding and knowledge of the etiology and pathogenesis of acne so that these insights can be directed towards the development of effective treatment.