Hi prettybow, try using pure manuka honey. It can be applied directly on skin or taken internally as a substitute for sugar. It's all-natural so you don't have to worry about the side effects. I've been using it for a month now and I can see improvements with my skin.

If you're only getting acne on the back and shoulders--could it be because this is where you hair comes into contact with the skin? I use a pretty oil-dense conditioner because my hair is so dry, and if I don't rinse my back as the last step in the shower I get very similar breakouts there. Maybe try not letting your hair touch those areas and see if it helps before starting the spiro

I am taking spiro mostly for back acne that is cystic. I also have acne on my face, but not like the cysts on my back. I took 50mg for 3 months, and upped it to 75mg for the last 5 months. I have noticed quite an improvement in my face (less oil, basically no pimples, still have blackheads), and some improvement on my back. I still get cysts - maybe 5 a month instead of 15-20 before. My chest is much improved. I think it is slowly working and that i probably need to be on 100mg to see really good results.

I also took 2 courses of accutane, which cleared me totally for 2 years each time. I tried BP for years, with little success. I've tried everything else (honey and making sure my hair is up among many other things) and spiro has helped me more than anything else except accutane. I've had no side effects, except a little weight loss.

Spiro only works so long as you take it. I took it for 2 years, had clear skin, but was forced to stop due to side effects. All my acne and oiliness has come back. So it's a lifelong commitment. The effects stop within about 1-2 months if the medication is stopped. It's not like Accutane where you can take it and sometimes have clear skin for a few years after you've stopped it.