Hi Shawn, I come from a family where horrifying cystic acne is the norm for females on my mother's side. She struggled with it all her life and still does at 55, so when my sister and I developed it as teens she took us straight to a dermatologist. Like you, we tried everything, including scary long antibiotic regimens, because we were petrified of the terrible reported side effects of Accutane. Finally though we were desperate enough to give it a go.

We were on a pretty strict diet with no alcohol allowed and a high vitamin d dose to mitigate some of the damage. Make sure you stay up on your regular blood work to make sure everything is in order with your liver.

This is the critical part- after about 4 months, our acne seemed to be worse. Much worse. And the skin cysts HURT all of a sudden, not to mention horrible skin dryness, cracked lips and hands, and sensitivity to sunlight. My mom could not deal with the side effects and figured like everything else this drug did not help. My sister and I decided to stick it out. After 6 months, we turned a corner and our skin started clearing up. Even the side effects seemed to diminish (although that could just be the joy of seeing the treatment working.) While my mothers still struggles with her skin, I'm happy to say both my sister and I have clear skin now with only very minimal scarring. I get the occasional little pimple now but it's hardly anything to worry about, and it's been 5 years since the treatment. The only lasting side effect is that I don't tan very evenly in the sun anymore- but it's probably nothing you would notice until I pointed it out.

So basically I'm saying, have patience. Sometimes it gets worse before it gets better. I wish you all the best of luck! Check in and let us know how it's going.

Both my sister and I used Accutane as teenagers to treat cystic acne that was not responding to other treatments (oral/topical antibiotics, retin-A cream, etc.)

After a few months of extremely dry skin, chapped lips, etc. (and actually worsening acne) my skin started to clear and since then I have had ZERO problems with my skin. My sister had the same experience as well.

If I had it to do all over again, I would do it in a heartbeat.

Years of failed treatment exert a huge emotional, psychological, and physical toll and IMHO it is worth taking Accutane as long as you are properly educated with regards to the risks and things that you can do to emeliorate them (i.e. avoiding anything that can tax your liver such as alcohol, having regular blood work to detecte elevated liver enzymes, etc.)

Note: My doctor accidentally prescribed me a double dose of Accutane so I was on 160mg/day during the course of my treatment. Despite this, I have no persistent side effects. The typical dosage is in the neighborhood of 40-80mg/day.

Getting ideal amounts of D and K can probably minimize (dramatically) the negative effects of accutane.

All the best to you!

Accutane was also the only thing that worked for me in my 20s, after trying everything else. It took 2 rounds for me. The first time I had a very conservative derm who would only prescribe me 40 mgs. My skin cleared up, but only temporarily. 2 years later I was breaking out with cysts again and went to another derm and got back on Accutane, this time going up to 100 - 120 mgs/day, which was at the high end of the spectrum for my weight. But it did the trick. Clear skin for 8 years now, unless I have too much dairy. I'm not sure that 10 mgs/day is going to be enough to keep your acne away long term. My only lasting side effect from such a high dose is dry lips. Not to the same extent that they were on Accutane, and nothing that a little Aquaphor doesn't take care of. For me, it's a trade off that was well worth it.

I got cystic acne in my late 20's too, and pretty much cured it using dietary changes. Basically i saw an acupuncturist/Chinese med doctor, and he gave me a list of foods to to eat and avoid, based on my personal diagnosis. Generally speaking (and assuming you are currently paleo)- nothing spicy, nothing fried, no caffeine, no sugar (small amounts of fruit), eating cooling foods: cucumbers, watermelon, dandelion greens. In addition, keep stress levels low and get adequate sleep. According to Chinese medicine, I suffered from "damp heat".

I tried Accutane in college too, and the first thing I noticed was mood changes, and I immediately quit using it.

Best of luck to you! I feel like I've tried everything as well. Ive had it since I was a pre-teen..and I'm 30 now...so I feel ya.

Bleh, went through a cycle of Accutane when I was a teeneager. Yes, it dramatically reduced acne, but also included seriously dry skin and chapped lips. Blissfully, I didn't know about or suffer the other side effects.

Looking over the Wikipedia entry, I wonder if there might be safer options? Wikipedia mentions that its benefits (and side effects) are due to its close resemblance to retinoic acid.

Maybe just upping your Vitamin A levels (cod liver oil) or upping Beta-Carotene intake? And then, as Katherine mentions, upping Vitamin D and Vitamin K to control the Vitamin A toxicity.

In 2009, Roche decided to pull Accutane off the US market after juries had awarded millions of dollars in damages to former Accutane users over inflammatory bowel disease claims. Among others, actor James Marshall sued Roche over Accutane-related disease that resulted in removal of his colon.

I don't see why you'd use accutane instead of just retinol. I noticed you asked a question about retinol in the past, so maybe you already tried that, just wanted to make sure.

If the retinol doesn't work though, I doubt the accutane will. I remember seeing someone taking accutane and while it did clear his skin of acne it was peeling and inflamed and he had swollen, dry lips so there was no aesthetic improvement.

But if nothing else works, it's worth a try.

I did a low dose of accutane for 2 years on my dermatologists recommendation. That was a few years ago and my acne just ended up coming back again and again. The only thing thats worked for my has been a carb intake below 100 grams a day. Cutting out chocolate, and eating organic where I can. I am 28 and for the first time since i was 13 I don't have acne anymore...not sure what your diet is like, but it took about 3 months of super clean eating to clean up my skin..but it did clear up. I just wash my face with regular soap now and thats it. Accutane really does just cover up an underlying problem, and can really cause more problems then it solves. But on the other hand, it definitely is easy and does clear up the acne.

Have you tried GAPS?

Get your hormone levels checked.

I went on the anti Candida diet and without even knowing it my skin cleared up. Anti Candida is a very strict diet. I read that you tried everything, does that include strict diet changes? I know everyone's skin is different and stronger methods are sometimes necessary. As others have noted, please be careful with accutane because from what I've researched it is related to Crohn's disease and ulcerative colitis. Two very serious diseases that involve inflammation of the intestines and uncontrollable bleeding.

I’ve done low dose isotretinoin and its pretty good TBH no noticeable side effect and easy to tolerate. It didn't keep my skin clear all that long afterwards, which was disappointing, despite a near 18 month course.

I found that masses of vit A (40 Kiu) from halibut oil and liver a great help but I also needed to get lots of sun to avoid dry itchy skin. This is how I’m dealing with it ATM and I’m happy to be avoiding drugs like isotretinoin.

Adding pregnenolone and desiccated thyroid perfected what the Vit A started.

I understand your frustration and good luck with what ever regimen you start

Yeah, please keep the updates coming, I am very interested in how this will turn out for you. I've been considering doing the same thing for a while now. Nothing else seems to work...

Vitamin D was what finally fixed my acne after what seemed like a lifetime of suffering. I was in my mid-thirties. The key point -- one I'd missed before -- was that I was not getting nearly enough of it to make any difference.

I had to take a liquid form of cholecalciferol at doses more than of 5000 IU a day before things really changed. I noticed that my skin temperature went up. Lo and behold, my skin started to clear up. I verified my levels with blood testing. The improvements did correlate with the 25-OH-D level.

I also eventually found, after a few self-experiments, that vitamin A actually made the acne worse, unless I took doses so high I started to get the toxicity symptoms (joint aches, super dry skin; the "therapeutic action" of Accutane - isotretinoin - is really just a toxicity symptom of vitamin A).

Along with that, I took substantial amounts of Omega 3 from fish oil (four capsules a day was typical for several years). The striking thing about this is that it took months before I saw the biggest improvements. I realize in retrospect that I gave up much too soon on some of the things I tried.

Oh, and my diet? It is essentially paleo, and devoid of junk. The only sweet things I eat are fruits, and then in very limited amounts. This is really hard for many people to do. I often meet people who claim they are strict, then when I observe them see that they cheat - a lot.

All these things together have given me the clearest skin I have had in my whole life.

I suspect that there is a connection between acne and intestinal health. All those years of antibiotics have likely screwed up your intestinal flora completely. You might want to consider an anti-inflammatory regimen typically used for reactive arthritis, in which you actively try to repopulate your large intestine with beneficial organisms. One thing I have not heard anyone try for this sort of thing yet, but would be curious to test, is a fecal transplant, but those are not generally used for things like acne and you will probably have a hard time finding a physician willing to do something like that.

All the other things, though, are doable, and if you haven't tried them, I'd give them a look. Acne sucks.

Remember that acne is primarily an inflammatory condition. Anything you can do to mitigate inflammation is likely to help and certainly won't hurt. Good luck!

Awesome, awesome! I'm really considering giving this a go now. Please keep the updates coming!!!

You sound similar to what I was like. Do you have oily skin patches as well? I used to have really bad cystic acne up to the age of 21. I got fed up when I was having 5 cysts forming on my face at various stages at one time. I had facial redness, dry body skin, and chronic chapped lips. My hair would get oily too.

To find out I was combination skin, but instead of dry and oily in the different places, I was dry and oily in the same place at the same time! I still argue with people to this day that this skin condition exists while asia it's considered a real skin type and it's quite common.

I am wondering if you have a skin type like mine? It's hard to treat it correctly when western skin care does not generally recognize an oily/dry skin type as described above.

There's also a perpetuating myth that if you're oily in an area, then that place is moisturized. This is not always the case! If your skin has trouble producing it's own moisture and tends to draw it from the air then an oil on top will serve as a barrier to keep the moisture out.

This is exactly how my skin behaves. Dry skin -> produces some oil -> no moisture -> Oil hangs out in T-zone instead of spreading evenly -> skin under T-zone can't draw moisture from air and flakes off into the oil -> dead skin and oil film develops and clogs pores -> wash face, but cannot get film off without scrub -> dead skin builds up over time -> acne.

I found a website in college that really helped me out (which I'm sure is impossible to find now that's been 6 years ago).

• I started being gentle to my skin instead. I started using a gentle cleanser like Purpose, CeraVe, or Cetaphil. I washed every morning and night with lukewarm water.
• When I got the cysts I iced them to bring down the swelling as the Zeno can leave brown marks. Some people have reported finding a entire face gelly mask that they put in the freezer to use every night to keep the cysts at bay. That or icing cyst prone areas.
• I also found out that I'm allergic to Benezyol peroxide (using a strong dose every night all over as part of the plan). So I switched to salicylic acid instead.
• It would also take 2-3 months to see results because acne causing bacteria can incubate in your skin, so I kept at it.

This relieved a majority of my symptoms even though I was exercising and eating clean for a good 4 years before that. Once my skin healed somewhat, I realized I got skin build up and started using scrubs in order to use make up (I never used make up before but wanted to so badly without looking like a flaky mess.)

I'd still have a greasy T zone and small breakouts here and there. My pores would be still be dirty, and I could not get rid of the dead skin with a mere wash cloth. The OTC scrubs weren't abrasive enough even for daily use.

Once I figured out I was dry all over I attacked everything with water based/gel moisture's and hyaluronic acid. For me opaque moisturizers tend to leave residue that contributes to the build up so I avoid those.

When I started moisturizing with hyaluronic acid, the following happened,

• My hair wasn't as greasy as I thought. It was just picking up the oil on my forehead at night.
• My oil started to distribute itself more evenly across my face and I started to glow.
• Pores were hydrated enough to allow me to more easily wash off dirt and effectively use products like Biore strips (before they would not pick dirt out of my pores and extracting devices did not work at all!).
• My pores would stay clear longer and were more able to flush out on their own.
• I'd wake up with no facial redness (not rosacea). Of course touching it or rubbing when splashing water would redden it a little. Still, an big improvement. Crisco did the same thing for redness overnight for me (was trying to find a La Mer cream substitute), but obviously I don't like my pillow greasy. Hyaluronic acid was a much better choice.

Everything is not perfect. I won't lie. I still have to scrub, just not as frequently now and not as hard. I do get acne but nothing like it was before.

Since Accutane can be very drying so you might be interested in below,

Hyaluronic acid has the ability to absorb large amounts of water which can help keep your skin hydrated. You have to apply enough moisturizer when using it so it doesn't draw moisture from your skin though. Applying the moisturizer in layers on a damp skin helps. It will even draw humidity from the air.

CeraVe has a creamy moisturizing facial cleanser with hyaluronic acid in it for normal to dry skin. I also use it on my face, and like a body wash from time to time with cool water letting my skin air dry. I prefer this over a harsher cleanser and lotion.

You can also obtain hyaluronic acid in serum form. It's really hard to find in regular drug stores though. I found some at Walgreen's and I had to scour the ingredients on almost every bottle. It's difficult to avoid stuff that says 'firming' as firming ingredients tend to be drying.

Garnier makes a grape seed extract moisturizing gel (blue green jar). I switched from a white lotion to this and experienced less build up. The stuff with the sunscreen in it seems to be the worst for build up. If I need protection on my face, I'd rather do a wide brimmed hat.

I hope what I have written here will help someone out.

I read on Chris's Kresser Facebook page that eating liver twice a week will help with acne, he has 4 articles in which he discusses skin health, he also recommends taking Green Pastures fermented butter blend/ cod liver oil, I will give that a try but am getting pretty close to trying out accutane, thank's for the updates. I have found out that nuts aggravate my acne.

I know you said you've tried everything, but I thought of mentioning some things just in case they can be helpful:

Have you tried a nightshade-free and low omega-6 diet?

Apple cider vinegar (perhaps diluted the first time you try, to make sure it doesn't sting) and coconut oil topically may not cure, but might help. http://www.earthclinic.com/CURES/acne.html

Some people have mentioned healing with this protocol: http://www.acne.org/regimen.html

I hope you get improvements soon, one way or another. :)

Oh, I did start acutane once for skin problems (not acne), but it only gave me side effects, so I regret taking it.

Have you tried a high dose cod liver oil regimin? Why not get the vitamin A from A natural source? Also, have you looked in to treating for a dermodex mite infestation? I know this approach has helped keratosis pilaris and rosacea sufferers. I've seen anecdotal evidence on the rosacea forums that it helped people's acne too. The high vitamin A helps my KP and then I've been experimenting with a dermodex killing regimin using camphor and sea buckthorn oil and borax. There's lots of stuff on it on the Internet. I'll edit this post when I'm on my computer and include some links. A lot of cystic acne sufferers also have rosacea so it may be related.

Keep with the accutane if it's working, I'm not trying to convince you otherwise but there might be other routes besides diet or drugs that you havent tried. And this might help with the lingering redness

Yeah I would make sure you were getting enough vitamin D and also eat mass amounts of fish oil.

I took accutane when I was 16 for my severe acne and it destroyed my liver! Be careful about drinking when you're on it. I'm dealing with serious problems in my life now because of the accutane I took 4 years ago (and my acne came back regardless).

The one thing that instantly cleared up my skin (after about 8 years of struggling with antibiotics, lotions, creams, meds, etc) was getting tested for food intolerances and then cutting out those foods.

I have been taking 20 mg every 10 days for 2 years. I seldom get any pimples, if I do they are very small. I first took the full course treatment in 1982 and it was effective but I had to repeat it twice within the first 10 years.

I stopped drinking alcohol 30 years ago when I was 24. I can state definitely that alcohol made my acne worse.

I have found that the low dose (20 mg every 10 days) is very effective. My skin and hair remains dry and I have virtually no acne. If I take 20 mg every week then my skin and eyes become too dry. If I take 20 mg every two weeks then my skin starts to become oily.