BACKGROUND: Acne vulgaris (AV) is a chronic inflammatory disease in the pilosebaceous unit. Recent research has begun to focus on the essential relationship between oxidative stress and the pathogenesis of AV. The use of antioxidants like coenzyme Q10 (CoQ10) that has various advantages as adjuvant therapy is expected to be beneficial for AV. AIM: The study was aimed to analyze the effect of CoQ10 supplementation on serum SOD levels and the severity of AV patients. METHODS: A double blind-randomized controlled trial was carried out on 36 patients with AV and classified according to severity degree of AV. These patients were randomly divided into two groups (treatment group with tretinoin 0.025% cream and once-daily supplementation of CoQ10 100 mg tablet; and placebo group with tretinoin 0.025% cream and once-daily placebo tablet). Response to treatment was based on serum superoxide dismutase (SOD) level and AV severity degree. RESULTS: Administration of CoQ10 to AV patients significantly increase serum SOD level (p = 0.008) and improves the severity of AV after 8 weeks (p = 0.008). CONCLUSION: CoQ10 supplementation can increase serum SOD levels and improve the severity of AV.