EARLY systemic treatment of severe juvenile acne may prevent permanent scarring and reduce long-term psychosocial burden. The findings emphasize timely assessment, individualized systemic treatment, and careful consideration of physical and psychological disease burden. Severe Juvenile Acne Treatment Requires Early AssessmentThe review examined evidence published from database inception through March 2026, focusing particularly on systemic therapies for severe juvenile acne. Oral Isotretinoin Remains the Gold StandardOral isotretinoin remains the gold standard for severe nodulocystic, scarring, or treatment resistant juvenile acne. Future severe juvenile acne treatment is expected to become increasingly personalized, microbiome conscious, and targeted toward inflammatory pathways.