Most acne therapies require a minimum of six weeks of use before improvement is seen. Although topical therapies are standard of care for mild to moderate acne, hormonal agents provide effective second-line treatment in women with more severe acne regardless of underlying hormonal abnormalities. It is not necessary to demonstrate androgen excess to achieve a benefit from antiandrogen therapy, Kraft and Freiman add. Kraft and Freiman add. Kraft and Freiman add.