Acne vulgaris is a chronic inflammatory disorder of the skin. Low level of adherence to acne patients to treatment can lead to poor clinical efficacy, increased healthcare costs, and unnecessary treatments that can lead to adverse drug reactions. The aim of this study is to compare the level of adherence to acne patients between Greece and Bulgaria. A multicenter observational study utilized self-completed questionnaires to assess medication adherence among patients visiting 45 pharmacies throughout Bulgaria and Greece between May and December 2018. A total of 225 patients were included in the study. Subjects included acne patients undergoing treatment who had a medical consultation prior to the study. All patients had acne therapy prescriptions. The likelihood of adherence was assessed using the Elaboration díun outil díevaluation de líobservance (ECOB) Adherence Questionnaire. Adherence Questionnaire. The ECOB scale was translated into Bulgarian and standardized by forwarding translation, backward translation, and a pretest. The data collected were proceeded through SPSS ver. 22.0. According to the ECOB scores, good adherence to treatment was documented in 42.0% of the Bulgarian patients on topical treatment and 39 on oral medication. For the Greek patients, good adherence to topical medication was judged to be good for 53% and 40% in oral treatment. Greek and Bulgarian patients show a similar level of adherence to acne treatment ñ a high rate of non-adherence. Perhaps patients could be monitored about their adherence and this can be performed in the dermatology clinic or the pharmacy.