Background: The treatment selection in acne vulgaris (AV) is difficult due to challenging assessing severity; therefore, it should depend on a proper history, physical examination, previous treatment and response to treatment.

Aims: The aim of this study is to investigate the differences in sebum composition and skin pH in patients with moderate to severe acne vulgaris to identify lipid markers in comparison with the apparently healthy group and to study the effects of isotretinoin or azithromycin on the level lipid profile, liver enzymes, in addition to sebum composition.

Methods and Material: This study was conducted on sixty women patients with AV and thirty, apparently healthy individuals as a control group. The patients were allocated into two groups, A and B, group A was given 500 mg of azithromycin taken on alternative days for 3 months and group B was given 40mg/day isotretinoin for 3 months. Before and after therapy serum cholesterol, TG, ALP, ALT, GGT, creatinine additional to sebum cholesterol and squalene levels were measured. In the healthy control group, these parameters were assessed only once.