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Acne is a chronic inflammatory skin disease with a recurring nature that seriously impacts patients’ quality of life. Currently, antibiotic resistance has made it less effective in treating acne. However, <i>Paris polyphylla</i> (<i>P. polyphylla</i>) is a valuable medicinal plant with a wide range of chemical components. Of these, <i>P. polyphylla</i> saponins modulate the effects in vivo and in vitro through antibacterial, anti-inflammatory, immunomodulatory, and antioxidant effects. Acne is primarily associated with inflammatory reactions, abnormal sebum function, micro-ecological disorders, hair follicle hyperkeratosis, and, in some patients, immune function. Therefore, the role of <i>P. polyphylla</i> saponins and their values in treating acne is worthy of investigation. Overall, this review first describes the distribution and characteristics of <i>P. polyphylla</i> and the pathogenesis of acne. Then, the potential mechanisms of <i>P. polyphylla</i> saponins in treating acne are listed in detail (reduction in the inflammatory response, antibacterial action, modulation of immune response and antioxidant effects, etc.). In addition, a brief description of the chemical composition of <i>P. polyphylla</i> saponins and its available extraction methods are described. We hope this review can serve as a quick and detailed reference for future studies on their potential acne treatment.