Hey guys. I've been looking on this site for years but I finally decided to join because I've been feeling really beaten down by my struggle with acne. Im 21 years old and have been struggling with acne since I was 13ish. I've tried a lot of things to get it under control. It is nowhere near severe and disfiguring acne that some people suffer from, but it is persistent and cystic. Big cysts and lumps that are usually on my chin or cheeks, usually I'll have a cluster on one cheek and another will be fine, and then it'll switch sides. My cheeks have scars and hyper pigmentation from years of this nonsense. I've tried; proactiv, antibiotics, epiduo, the acne.org regimen, and many many many different brands of dash washed, creams, including organic stuff blah blah blah. (Notable to mention, I have PCOS and have a mirena IUD, which I have been thinking might contribute to these cysts, but I had acne cysts before the IUD as well) This past summer I went to a dermatologist again to try to get my problem under control. She prescribed me retin A 0.025% and spironolactone. I've been on the spiro for about six months, and the past few I finally thought it was helping. I had little to no cysts, though I was struggling with texture issues still (I think the retina a May have made that worse?) anyways....lo and behold last week I had a bad breakout including a huge cyst (featured below). I am extremely disheartened because I thought the spiro was finally making it better. But here I am again with another cystic breakout I so desperately wanted to avoid. New scars to look forward to...I made another derm apt for december, and I'm thinking seriously about accutane. I'm very down, and I don't want to do anything because I don't want anyone to see my nasty face. I would love any support, and advice especially if you've suffered from a similar type of acne. Thank you