I haven't taken accutane lately but just wanted to say that I'm so sorry you're having to deal with chronic cystic acne --- sucks! I'm 63 and struggled with cystic acne my whole adult life. I did 2 rounds of accutane in my 30's and had five years of clear skin before the cysts came back. Ugh! Full strength antibiotics kept me somewhat clear but you can't do that forever. Topical BP was too harsh, same with salicylic acid. Finally returned to my old derm who is a specialist in adult acne and have now been clear for two years. Thought I'd share what finally worked.

He has me on a trio of treatments that work together to keep pores open and kill acne bacteria without upsetting my sensitive skin. Once a month he has me do a microdermabrasion to get rid of dead cells, open pores and allow the other meds to work. I wash with a BP cleanser patented to clear acne (see below). Then I use a topical antibiotic (Cleocin-T) in the morning. Followed by DML lotion which was developed for sensitive acne skin. Great base for powder make-up. At night I wash with Galderma antibiotic bar cleanser and more DML lotion to soothe the skin. Chronic adult acne is very affected by inflammation so everything has to be done with that in mind. I also take Spiro but I'm not sure how much it is really doing since I've taken it for 10 years and before being on this current regime I still broke out.

Another thing that made a HUGE difference was switching to a whole unprocessed foods diet where I avoid all oils, dairy, sugars and alcohol. Avoiding oils really did the trick. I eat very fresh foods and drink lots of water.

Thanks so much for sharing your regimen with me. Good to know there do seem to be alternatives out there, and I'm glad to hear you are clear!

I'm beginning to suspect that in spite of what I've been told all these years, diet may play a factor in my skin problems. While I absolutely refuse to give up caffeine at this point I am going to try to cut out dairy, sugar, and alcohol and see what happens. I wish I could take Spiro, but it made me terribly dizzy the first time I tried it several years ago. Two months ago, my derm tried me on it again (the doxy stopped working), 50 mg daily with the instruction to take it at night. No dizziness, but I was so, so tired and foggy, and I was struggling to get through my workouts. No energy, sometimes out of breath. I asked my doctor if the side effects would eventually go away and she said she didn't know, probably best to stop. I also got a terrible IBsome of the worst, most persistent breakouts I've ever hadand it's still continuing. So I'm back on the doxy, waiting until June 25 for my second blood test so I can start Accutane. I have to admit, even though I experienced nearly zero side effects the first time, I'm terrified that my body won't be as gracious this go round. But at this point, I feel like it's my only recourse. If it doesn't help, I'll definitely investigate some of the options you describe.

Your diet changes will help. What also will help but is not talked about much is avoiding all processed oils (salad dressings, mayo, cooking oils, etc.). I also did not think diet could affect acne that much but then I embarked on research for several years that showed how much we have departed from more traditional diets. People that follow these traditional diets do not have acne! The traditional diets typically are made up of wild meats and fish, fresh produce, whole grains, tubers for starch and no oils. Meats are cooked in stews or steamed or if sauteed...they are done so in their own naturally occurring fats. Processed oils are a recent phenomena as a result of industrialization where oils could be mechanically extracted or with harsh solvents. Look it up...it is very interesting.

When I went on the trio of med treatments (BP cleanser + cleocin-T + microdermabrasion) the cysts stopped within 2 weeks. I am not exaggerating. I was still breaking out with smaller less inflammed zits tho. This led me to research about diets and eliminating all processed foods and avoiding dairy, sugars, caffeine, and alcohol. Then the final thing last summer was to avoid all processed oils when I finally admitted to myself that the cultures without acne really did not eat salad dressings, mayo, or butter or margarines! This made an incredibly dramatic change in my skin...it got less oily and the little zits went away. My skin keeps getting better and better. I'm not sure what it is about processed oils that makes acne worse but it may have to do with how our body responds to such a concentrated food...it becomes more inflammed and then more clogged up.

It is worth a try to avoid oils along with the other diet changes. You will see a change in your skin texture within 2 weeks but the changes keep on happening. I think my body digests food better without all the added oil and butters.

It could be that most adults with chronic resistent acne have an underlying rosacea issue that manifests as papules and pustules, along with other acne problems. If my hunch is correct then also avoiding typical rosacea trigger foods will help.