Rational acne therapy remains an urgent task. The tactics of treating patients with acne is determined by the clinical form and severity of the disease, the gender and age of the patient, the effectiveness of previous therapy, the presence of concomitant diseases, the patient’s compliance with therapy, the characteristics of the development and course of relapses, and their duration. According to current international recommendations, the isotretinoin is one of the most effective drugs for the treatment of acne. It presents the retrospective analysis’ results of the efficacy and safety of systemic isotretinoin usage in the treatment of 30 patients with severe forms of acne aged 12 to 45 years. Patients were under supervision from September 2019 to November 2020. All patients received isotretinoin as monotherapy at a dose of 0.5-1 mg/kg/day and a cumulative dose of 120-150 mg/kg. The analysis showed that therapy with systemic isotretinoin in all patients made it possible to achieve clinical recovery and remission of the disease, as well as to improve patients’ life quality. The absence of drug self-withdrawal cases by patients throughout the course of treatment indicates a high patients’ compliance to the therapy. After completion the course of treatment, 7 (23%) patients were prescribed supportive therapy with external preparations containing adapalene or azelaic acid in order to ensure long-term remission of the disease. High efficacy and favorable safety profile make it possible to recommend the use of systemic isotretinoin as monotherapy for severe forms of acne in real clinical practice.