After 20 years of dealing with acne, Ive found what the cure was for me. Ive been watching these boards for about 10 years and have tried literally anything and everything that others have found success with. Because of all the advice Ive read over the years, I felt an obligation to share what I found. In order to put this in perspective, I need to tell the story of the last 20 years of treatments. I started on Retin-A at the age of 15 when I started breaking out. This worked great after the initial painful months of breakouts this medication creates. After a number of years though, I backed off the treatments because I thought the breakouts would have subsided because of age. No such luck, and I went through another 5 months of terrible breakouts in order to come out the other side of Retin-A. My derm didnt prescribe antibiotics during the first few months of the Retin-A, which is something I recommend to anyone getting on that medication. While the Retin-A helped, it became less and less effective over the years. Ive blended in a number of other topicals with the Retin-A and was always treating breakouts after they occurred. Numerous cycles of various antibiotics and three separate cycles of Accutane did not clear it up long-term. I can say that during the Accutane treatments my face was clearer than at any other time and I highly recommend it to those that tolerate it. The only side effect I had with Accutane was chapped lips and some dryness, but it completely eliminated breakouts during the treatment, which was amazing. There have been a number of people talking about depression while on it and the inability to drink alcohol. I enjoy a glass of wine or two on weekends and never had any elevated liver enzymes. I watch my fat intake and am almost a compulsive healthy eater in an effort to curb the breakouts. Additionally, I dont know anyone that is dealing with breakouts that isnt ecstatic when they come across something that solves the problem, so depression was definitely not a problem. In fact, I was happier than Ive ever been because there was no concern about breakouts. Like everything else Ive tried, the effects were short lived and the breakouts always came back. My dermatologist had no answers, so last spring I was reading the threads looking for anything that could be the next solution. Someone had posted results using large amounts of Vitamin A, so I went the Vitamin Shop and bought some. Within a week I had completely cleared up again, just as I had been on the Accutane. At this same time, I Googled acne specialists in my city and found a new dermatologist. What happened next has amazed me. She recognized that the Vitamin A dried me up enough and that I couldnt stay on full-strength Accutane forever. She also said that Vitamin A metabolizes in the liver and that prolonged high doses of it are not good for you. We also recognized that I have a job that is very stressful and demands a lot of my time, so I was not sleeping well and was experiencing high levels of stress (and had been for years). I had always disregarded the impact of stress, but now have a different opinion on it. Here was my solutionShe prescribed 40mg of Absorica once per week and twice daily application of Aczone. Make sure you get the coupon from your derm because Aczone is unreasonably expensive otherwise. Absorica is a new version of Accutane that is more easily absorbed by the body. I took two pills a week for the first 2-3 weeks and then tapered off to one per week. I also lowered my stress level and began balancing out my life with meditation and physical exercise at least 4-5 times per week. Once my face cleared up, I began seeing red bumps appear and was originally treating them as acne. We subsequently discovered that it was rosacea, which appeared to me as the beginnings of a cyst. I have now identified stress as the trigger of these, and can get them to almost completely disappear with a combination of an ice pack (reduces the inflammation and heat) and Aczone. It recently got pretty cold where I live and I noticed additional bumps that did not respond to the Aczone. Again, I have sensitive skin and this was a mild form of eczema, which is easily treated with Metronidazole. Since breaking out affected my confidence so much and I had such a desire to maintain these results, I have made a number of changes in my life since this discovery, including a job that is much more enjoyable, Im making sure to reduce my stress levels, and increasing the amount of sleep I get at night. On a side note, since I recognize that inflammation and heat is a key factor in all of this, I am doing everything I can to reduce the things I ingest that could cause inflammation and am taking additional supplements that are supposed to reduce inflammation. Im not sure how much these help, but Ive thrown everything at this and will now be tapering off some of this in an effort to identify exactly what I do and dont need to keep these results. The other supplements are fish Oil, Vitamin E, Wobenzyme, which has been extremely helpful with an old back injury as well, and Acnease. This costs a lot of money right now, but its worth it. Additionally, I know that as a kid I was allergic to dairy and wheat, and even though I can eat them without a noticeable reaction, I know that they can cause inflammation and have substituted almond milk for regular milk in my smoothies and have reduced my wheat intake. I have a job that requires me to be in front of clients and can now schedule meeting without a concern of if I will be in a breakout cycle or not. Again, I feel an obligation to pass on what took me over 20 years to discover and hope that this helps others on this board to have a more enjoyable life, it has definitely changed my life for the better.