Acne vulgaris is a chronic inflammatory skin disease involving the pilosebaceous unit. Improper management easily leads to post-inflammatory hyperpigmentation and scarring. Therefore, treatment needs to address both lesion improvement and scar prevention. Topical drugs include retinoids (e.g., adapalene), benzoyl peroxide, antibiotics (e.g., fusidic acid), azelaic acid, and dapsone, with key differences in their mechanisms. Retinoids reduce comedo formation by regulating keratinocyte differentiation. Benzoyl peroxide kills Cutibacterium acnes and exerts anti-inflammatory effects through oxidation. Antibiotics inhibit bacterial protein synthesis. Azelaic acid has antibacterial, anti-inflammatory and keratin-regulating functions. Dapsone exerts antibacterial and anti-inflammatory effects by interfering with folic acid synthesis. Clinical studies have shown that third-generation retinoids, benzoyl peroxide and fusidic acid significantly improve inflammatory lesions, while azelaic acid attenuates post-inflammatory hyperpigmentation. Combination regimens not only enhance efficacy but also reduce the risk of drug resistance, providing a scientific rationale for multi-target intervention in acne treatment. In addition, traditional Chinese medicine herbal therapy is widely used in acne treatment, opening up new strategic directions for the diversified and comprehensive treatment of acne. Based on this, this paper reviews the clinical progress of the aforementioned drugs in improving skin lesions and preventing scars in the treatment of acne vulgaris, aiming to provide reference for clinical practice.