• Review focuses on the treatment options for adult female patients with acne. •Acne in adult female patients may start during adolescence and persist or have an onset in adulthood. •Acne has various psychosocial effects that impact patients’ quality of life. • Treatment of acne in adult women specifically has its challenges due to the considerations of patient preferences, pregnancy, and lactation. • Treatments vary widely and treatment should be tailored specifically for each individual woman. • We review conventional therapies with high levels of evidence, additional treatments with support from cohort studies and case reports, complementary and/or alternative therapies, and new agents under development for the treatment of patients with acne.