Disclaimer: I am not a doctor, this is just one man's experience.

The beginning of my story is common. As a teenager, starting at age 14 or so, I had moderate acne with brief periods of cystic acne. This moderate acne continued for most of my life since. Now, at age 30, after over a decade of testing various improvements, I am nearly acne free, and acne-free when I follow the protocol below strictly (anything I say I do rarely, don't do at all for the strict interpretation) .I just want to record here the things that have made a difference. I remember reading some people here having a theory that acne is at its root a digestive problem that manifests itself as a skin condition, and, frankly, I think they are right.

Diet: I eat very little to no processed sugar, and restrict fruit. I eat very little to no dairy. I restrict greasy and oily foods like french fries and potato chips. My diet mainly consists of water, black coffee (caffeine is probably not great for acne, but I almost always have just one cup a day), raw vegetables (spinach, cucumber, some carrot and some green beans), meat (mostly chicken and beef), eggs, potatoes and rice. Alcohol is also bad for acne, although I drink occasionally.

Topicals, Rx and Otherwise: Duac, topical Retin-A (both nightly) and a twice-daily (wake-up and bed-time) tea tree oil face wash from The Body Shop. I have in the past used concentrated tea tree oil as a fairly effective spot-treatment, but be careful with it!

Supplements:

a) Appropriate Betaine HCL dose before meals. This is a digestive aid which increases stomach acid and I think I have very low stomach acid.

There are tests you can do for this, there's pages here on it. I used to drink lemon juice all the time which helped a ton

and I think has an effect in a similar way (but wears away enamel). I use NOW brand. You basically take as many pills as you need and reduce the dose

once it causes a heart-burn like reaction.

In the morning during breakfast

b) Chlorella and Spirulina, 3g each per day.

c) Barley grass in pill form, 5g per day.

d) Once daily mans multivitamin

At night:

a) 250 to 500mg time-release Pantothenic Acid depending on how good my diet has been (more used if bad).

b) I've tested L-carnitine, but not sure it makes a difference.

My general theory is this: Acne is caused by some digestion deficiency and the body tries to expel remnants of what is undigested/poorly digested out of the pores, causing infection and acne. Sweat (expelled through pores) is actually somewhat chemically similar to urine; you can find a NASA study on this. Each acne treatment I use attacks a different part of the process. Healthy diet reduces digestive problems. Digestive aid helps digest food that is eaten better. Barley Grass, Chlorella and Spirulina help clear out poorly digested food and are healthy themselves. Pantothenic acid reduce the amount of oil on the skin for acne to grow in/on. And topicals kill the acne bacteria - but at this point you are somewhat fighting a losing battle, without the previous reinforcements

Anyways, I welcome comments/questions on my protocol and theory. Best of luck.