Heya! Been lurking forever, haven't posted much but think I'm finally at the breaking point.
Quick background: Have had acne since puberty, only relief I've ever had was on Diane-35, which my gyno promptly took me off of after seeing my doctor had prescribed it. I do suffer from migraines as well, so the only pills she'll prescribe will have no effect on my acne. Have recently been diagnosed with PCOS, which explains quite a bit why no treatment has ever worked for me, whether it be antiobiotics, topicals, diet changes, etc. My acne at the current moment is quite severe (at least I believe so), with 5+ massive cysts at all times, uneven texture due to scarring & clogged pores, waking up with at least 2-3 new white heads on a daily basis as well. Needless to say it's really putting a damper on my life lately.
After some research I've now decided to try a lifestyle geared towards PCOS, no gluten, no dairy, the following supplements: Saw Palmetto, EstroSmart (DIM), Milk Thistle, Vitamn D3, Zinc & a Multivitamin daily. So far nothing new to update, but this is pretty much my last hope before finally trying Accutane... Which I did have a prescription for at one point & scared myself out of trying.
I'm thinking I should add in a fish oil as well, any suggestions? Also, anyone out there with PCOS & having luck treating your acne as well as the other symptoms that come with PCOS through a natural approach? I'd love any feedback/stories! Thanks 
Also terribly sorry if there are topics I've missed regarding the subject, I've looked through the forums quite a bit & thought I'd start my own, but feel free to link me to any particularily helpful ones if you'd like! xxx
Since you mentioned acne AND migraines, I'm tempted to ask if you have any mercury fillings or metal implants in your body? They might be adding to the inflammotary side of acne.
BCP was the only thing that worked for me as well. Don't do Accutane. It gave me the worst breakout of my life, not to mention the constant anxiety of scarring and other permanent damage to my body. I also had very little belief in it being a permanent solution for hormonal acne. I've quit after a month. Still trying to heal from that major breakout.
Milk thistle helps, not sure if it's a cure though.
I recommend adding Vitamin C 1000 mg to that regimen until you are clear, just for the purpose of healing faster/collagen building/minimize scarring. Fish oil is good, omega-3 is even better.
I've ordered B6 and inositol from US, to target my hormonal acne. Waiting for them to arive, fingers crossed.
Not to be negative but, I have PCOS and I have not ever found relief with herbal remedies. I implore you not to waste too much time with these if they start to make your acne worse. My acne is also severe, pretty much like yours, except I get nodules, which are even worse than cysts. If you have hirsutism or any other PCOS symptoms, your doctor may prescribe you an antiandrogen like spironolactone or flutamide.
I have PCOS too have had acne everywhere since I started my period. At the age of 22 my acne have worsened have tried herbal remedies such as Saw Palmetto and fish oil and I feel as though my acne got worse.
Don't want to take birth control pills for the rest of my life so been researching all over wondering what my next step is going to be.
Was wondering as you girls have pcos where abouts do you get your acne as I have it unusually over my chest and stomach??