So there are several treatments for cystic acne. The first one, and by far the best one, is Accutane. Accutane is a Vitamin A derivative. It's a pill that you take for six months. The reason it's such a wonderful treatment for cystic acne is that over 90% of people are better at the end of six months, and 70% of people never really get acne again. So not only does it help you while you're on it, but it puts you into a remission after you go off of it. It's a wonderful medicine that needs to be respected, as it's gotten a lot of bad press in the media. I'm a huge fan.
The second option is photodynamic therapy with red light. What this is is you put a medicine on your face and leave it on for an hour. And what this medicine does . . . and the medicine is called Levulan. What this medicine does is it makes your skin more sensitive to certain wavelengths of light. After sitting for an hour, you sit under a red light for about 10 minutes. What the combination of the medicine and the red light does is it helps shrink the sebaceous glands, just like acne cream does. The only downside to this is it's not covered by insurance, but it's a wonderful treatment for people who can't or don't want to go on Accutane.
The other treatment options like antibiotics, birth control pills, Spironolactone, they may help cystic acne a little bit. But I think if you truly want excellent results, you're looking at Accutane or photodynamic therapy.