Shanna M. Miranti, MPAS, PA-C, a Physician Assistant at Riverchase Dermatology in Naples, FL, and Hilary Baldwin, MD, Medical Director of the Acne Treatment & Research Center in Brooklyn, NY, review two challenging acne cases, including that of a young male who did not want to take isotretinoin and needed something to treat his oily skin in addition to the other pillars of acne and one of a woman who wanted to stop her spironolactone and become pregnant.