The etiology of acne vulgaris is complicated and characterized by two aspects, non-inflammatory and inflammatory mechanisms. The non-inflammatory aspect is represented by follicular occlusion by sebaceous materials and resultant formation of comedo. On the other hand, acne features the continuing occurrence of inflammation, which yields reddish popular or nodular lesions. Therefore, acne is not a simple infection with Propionibacterium acnes, but subsequent inflammatory changes are the nature of acne. New quinolones, macrolides and tetracyclines are used for the treatment of acne as topical or systemic drugs. Recent accumulated evidence has suggested that these drugs exert their therapeutic effects by not only bacteriocidal actions but also anti-inflammatory or anti-immunological actions. These effects include antioxidative action toward neutrophils, inhibition of cytokine/chemokine production and adhesion molecule expression by keratinocytes, and suppression of the antigen-presenting ability of Langerhans cells. Drugs possessing these anti-inflammatory capacities are clinically beneficial for the treatment of inflammatory acne.