Hello, I'm looking for some advice due to a 13 year struggle with acne that is still yet to be resolved. I've read these forums for a while but not had the courage to post before. I'm female and have what is defined by dermatologists as 'moderate' acne on my face, back and chest and a face that gets very oily. I get most kinds of acne (blackheads, whiteheads, papules, pustules). It has never been described as cystic although I do get some really big red spots. Throughout this time I've tried various types of treatment, including various types of topicals (adapalene, benzoyl peroxide, duac, isotrex etc), antibiotics, birth control and isotretinoin. I have always been very diligent and disciplined following instructions and length of time to use treatments for. I've never particularly had any kind of success with antibiotics, and after having an allergic reaction to Trimethoprim (which I was prescribed last year) I am fairly certain that continuing to try antibiotics to resolve my acne is not going to be successful and is potentially dangerous to my health. I've tried various alternative methods, including diet changes and vitamins, but again have not had success, and am generally in very good health and physically active. I really wanted diet to be my answer but I've never had a bad diet (always get fresh vegetables and fruit, green smoothies and cook most food myself - I like eating healthily). Unfortunately after various incarnations and elimination diets my skin did not look improved. The most successful treatment I have used is isotretinoin, but I had to stop after a couple of months due to aphthous stomatitis which meant that I couldn't eat properly for a good week. I've never experienced any kind of ulcer before taking it so I'm fairly certain it was the cause, although it did baffle the doctors I saw. Nevertheless this treatment produced the best clearing of my skin. But my acne returned after stopping it. I've had various blood tests done and the only thing that I potentially think could be related to my ongoing acne is low oestrogen levels. However, my GP was fairly dismissive and said that my blood test results were normal and said there wasn't anything to be concerned about. In fact, I was told at my last appointment with one GP that I've pretty much exhausted all treatment options. Birth control only mildly improved my acne but I still had it, and if anything, I've noticed that my acne is better around my period rather than worse (which is frustratingly contrary to most people's experience and most medical literature). I'm concerned that without some kind of intervention my acne will not resolve itself because my mother is in her 50s and still gets bad skin. Afterspeaking with various Dermatologists I think I have two options: spironolactone or a low dose course of isotretinoin. I am apprehensive regarding isotretinoin because of my previous experience, yet this is the only treatment that has really helped. I've not tried spironolactone yet which is why I'm leaning more towards that - and I'm also hoping it will help with my extremely oily skin - but wanted to know if anyone who has had a similar experience to me can offer any advice? Thank you.