Methods and compositions are described for the treatment of very severe acne vulgaris, including nodulocystic acne and conglobate acne. Compounds which inhibit either or both type 1 and type 2 isoforms of steroid 5α-reductase are administered daily in either oral or topical formulations to patients suffering from severe forms of acne vulgaris. Very high dosages of such compounds can effectively be administered oral just once a week and be successful.
