Don't be afraid of accutane. I had terrible cystic acne and did it twice in my late 20's. Only side effect was chapped lips. While on it I was clear (...a wonderful respite from cysts...) and afterwards my cystic acne returned but milder. Meds that never worked before began to work better. The regime I'm on now is the one that finally got me clear and has kept me clear now for several years. FYI --- full strength antibiotics did too but you can't take those forever. Also harsh acne topicals like BP and salicylic acid were too much for my sensitive skin. Here is the regime that got me clear. Using these things individually did not work...it is using them together that works.
BP cleanser (Panoxyl 4%) --- in the morning gently swoosh on for one minute and rinse with lukewarm water. Pat dry.
Topical antibiotic (Cleocin-T) --- apply in morning all over face and spot treat as needed at night.
Lotion for acne skin (DML) --- apply evenly with gentle strokes of fingertips, let dry naturally, don't rub.
Anti-androgen (Spironolactone 100mg) --- take one in the morning.
Mild cleanser (Cetaphil Antibacterial Bar) --- in the evening gently swoosh on briefly and rinse with lukewarm water. Pat dry.
Anti-inflammatory Diet --- this diet is for oily cystic inflamed skin --- avoid all dairy, sugary foods, processed oils (salad dressings, fried foods, etc.), nuts, caffeine, alcohol, spicy foods. Eat fresh whole foods.
Monthly microderms help keep more pores clear and help the topical meds to penetrate.
I really like a zinc supplement called "Opti L-Zinc". Studies have shown that most people with chronic acne have a zinc deficiency.
Hope this helps!