I too struggled with acne for decades...very frustrating and shatters any self-esteem for sure. I tried everything...everything natural and mainstream. Some things worked while I was on them (accutane, full-strength antibiotics, etc.) but acne came back when I had to stop. Topicals only inflammed my sensitive skin so eventhough I used BP forever...I dealt with red raw skin and continued breakouts. Tried meds for rosacea but they didn't take care of the persistent acne I also had. Long story short (...if you want to know the gory details message me for more...) what finally kicked out the chronic cystic acne was finding a derm who specializes in adult acne and then following his tx regime religiously without fail and without stopping. Here is his regime in a nutshell...
If your acne is really deep and cystic then taking at least one round of accutane will help lessen it. It may not go away but it will be less and other meds will work better.
If you are not sensitive to it, then retin-a is good for many types of resistent acne. There are many forms so a derm can determine which will work best for your skin type. Personally retin-a was too strong for me, although I tried it for years.
A combination tx is best and includes a BP cleanser + topical antibiotic (Cleocin-T) + monthly professional microdermabrasion (to open pores and suck out plugs) + oral anti-androgen (this is important if you are particularly sensitive to androgens - BCP or Spiro works) + low-dose Doxy if you also suffer from rosacea which many so-called adult acne sufferers actually have but attribute to acne.
This combination tx also works even better if you get allergy testing to determine common allergens such as gluten, dairy, etc. Personally I found out I must avoid dairy, sugars, nuts, caffeine, alcohol (sugars). Getting formal testing cuts out the guess work. For example I always thought I was allergic to wheat but I wasn't --- it was the sugars added to wheat products. Also cutting out all added fats can help reduce sebum which means less breakouts. I still use a bit of olive oil but hardly any. I also eat whole natural foods and avoid junk foods. This copies what people eat in cultures that don't have acne.
Hope this helps. It is based on years of personal experience, a specialized derm's advice, and lots of research.
Edited by cvd, 05 October 2013 - 11:29 AM.