Cystic acne by definition has a serious potential for long term scarring, discomfort, and psychological consequences to self esteem.
There are many topicals and options for oral antibiotics as well. However, these products only work by suppressing acne- buying time until we ‘outgrow’ it. These are not always long term solutions.
Accutane, or isotretinoin, is the only option that provides the potential for a long term solution and potential ‘cure’ for acne. This medication has been around for a long time- first FDA approved in 1982 and been available as a generic for over 15 years. It’s an oral medication taken daily for a window of time. The average duration of treatment is about 20 weeks. There are no special creams or cleansers- the pill takes care of the acne. It works at the level of the oil gland to treat the underlying cause of acne which is an overproduction or oil or sebum. By reducing this there is less likely to clog pores that leads to inflammation that leads to cysts that leads to scarring.
We do monitor blood work when starting treatment but it is overall well tolerated. We have to make sure that female patients are not planning pregnancies during treatment and for 6 months after completion. And we do screen for depression risks prior to starting on therapy. There are mixed studies on this potential side effect.
The bottom line is that there is no reason to suffer or struggle with severe cystic acne when we have a legitimate effective affordable option to treat. There is no reason to work through expensive topicals and over the counter topicals that cannot get to the cause of this type of acne. And, there is a lot of concern over long term antibiotic use for those that need something by mouth to help with acne. The beauty of Accutane is that it works. The small number of people for which acne recurs often do well with a second round of Accutane. The acne is never as severe as the first time around however.