Current data on child and preadolescent acne epidemiology, morbidity rate in different countries of the world, approaches to therapy now are presented. Modern knowledge of genetic, predisposing and exposome-factors in preadolescent acne development are described. Systemic therapy of this acne type has difficulties in tactics of choosing the treatment method in each individual patient. Currently, there are no regulated methods of systemic treatment of preadolescent acne. Isotretinoin is a well-studied drug, the profile points of which are moderate and severe types of acne, types of disease that are torpid to previously conducted therapy. Recently, indications for the use of systemic isotretinoin have been expanding worldwide, and the evidence base is accumulating. The article summarizes the experience of isotretinoin applying in different types of disease, presents the experience of isotretinoin prescribing in pediatric practice and demonstrates successful experience of preadolescent acne treatment by Lidose isotretinoin. The principles of cumulative doses set, working with daily doses, rules of laboratory monitoring of the therapy process, as well as issues of possible recurrence of the disease and its correction are prescribed.