I'm 22/M and had pretty bad acne since I was 14, currently 99% acne free 2 years post Accutane. I've always lurked these forums throughout the years as a source of information but never posted anything, so I figured this is my chance to share my story and answer any questions to the best of my abilities. Everything is personal experience and anecdotal - what worked for me may not work for you, and vice versa.
Moderate/Severe Acne. I used to have extremely oily and acne prone skin. I don't think I ever got huge cysts but I had big pimples that would burst and bleed and take a couple of weeks to go away. At a couple of points in my life my face was full of the stuff and I would frequently get comments from friends and even strangers about how bad my face is and how I should seek treatment. That should give an idea of how bad my acne was.
Benzoyl Peroxide. I used the 5% and 10% variants. Usually ordered them from this site. It does work eventually, but there are numerous downsides. You have to use a lot of it for it to work well, and it dries out your face and makes it extremely red, sensitive, itchy and painful. If you don't ramp up the dosage slowly and properly, or if you use it for prolonged periods, it will damage your skin. Most of my scarring occurred when I was using BP, even though I did not pick at or touch my acne. I would recommend anyone using BP to moisturise properly to minimize scarring, and to ramp down the dosage after using it for some time. The effects of BP are not permanent; once I stopped using it my acne came back in a couple of weeks.
Antibiotics. I tried taking a course of Doxycycline but it was a pretty bad experience. It just didn't work for me, and I would always get headaches after taking it, which is a common side effect. I never had the discipline to take it regularly as well. Finished the course anyway but I didn't think it helped with my acne at all.
Differin (and other Topical Retinoids). I think this is a good product for those with mild/moderate acne. I still use it occasionally nowadays because it makes my skin look better. If you use a lower concentration and apply a tiny amount, it won't cause too much damage to your skin (although you will still need to apply a light sunscreen). From what I've read, it is supposed to encourage growth of skin cells and "thicken" the skin while preventing blocked pores which cause acne. I think many people have bad experiences with topical retinoids either because they lack patience or because their acne is far too severe. If you're one of those with milder forms of acne, give this a try.
Accutane. This is what got rid of my acne permanently (2 years and counting). Because of the reported side effects, I used it as a last resort when I just felt so tired or dealing with my acne problems. My acne was moderate (not at my worst) when I started the course and I did not experience an initial breakout. 2 months in and my acne is gone and my oil production was finally normal for once in my life. I lacked the discipline to take my pills frequently and stopped the course after 4 and a half months against my doctor's advice (he recommended 6), but it still worked fine.
Post-Accutane and Negative Effects. My acne is 99% gone. My oil production ramped back up again, but I would say its only about 50% compared to pre-Accutane. Now lets talk about the side effects. During and after Accutane, my joints started hurting more, especially my hip and my back. I did a knee surgery during my course of Accutane and I believe the Accutane impaired my recovery process (it is well-known that Accutane impairs healing). I do a lot of sports and my body feels more "fragile" after taking Accutane. After I sweat, I get tons of red, itchy rashes all over my body and face and I have to take a shower immediately or it will get extremely uncomfortable. I never had such problems before Accutane. There may be other hidden long-term effects on my body. The bottom line is that it is a harsh drug and people should not take it unless as a last resort.
Scarring. I have mild-moderate scarring now after my acne is gone. I believe most of the scars appeared when I used too much BP, which dried out and damaged my face. I think moisturising and sunscreen is the proper way to prevent scarring. I did not use these products because they felt uncomfortable and they made my face look more oily, but I regret it now.
Laser. 6 Months after Accutane, I did a Mixto laser treatment with my dermatologist on low settings. It improved my scarring by about 10% and the down-time was about a week. Since my scars don't bother me or affect my confidence any more, I do not think I will be going for future sessions.
The Psychological Effects of Acne. I understand how tough it is to be going through high school with terrible acne. I did my best to stay cheerful, but I must admit that those were dark, gloomy days of depression. The only consolation I can give to anyone going through the same right now is that acne can be cured. If everything else fails, there is always Accutane. Don't believe everything on the Internet and do not use anything that could permanently damage your skin. Patience is the key. Its difficult to take a long term view towards treating acne, but there is no easy, short term solution.
I'll be happy to answer any questions about my journey.