Hopeful, what has helped most with my acne (the deep "underground" painful ones) is oral antibiotics and birth control pills. The topical treatments don't really help the deep cystic acne--the ones that hurt. I've taken oral antibiotics for many years. They use old ones not used anymore for other types of infections, so that resistance is not such a concern. I don't need to take them every day anymore, which is what my doctor said would happen. I now take a dose whenever I feel a cyst developing, which can often head it off at the pass.

The best thing that ever happened to my skin was when I had a problem with one of my ovaries and I had to take birth control pills for almost 2 years in order to prevent ovulation. My skin was the best it had ever been! I didn't need to take antibiotics when I was taking the hormones. Eventually, I got my ovary removed and so stopped taking the hormones. Within a couple of months my acne was back again, just like before.

There was one prescription topical product that could be helpful to me, and I used it for a decade. Unfortunately, they stopped making it about 2 years ago and there is nothing else like it on the market.

You just have to keep trying things until you find some things that work for you. There isn't really a cure, just different things you can do to help with prevention, some more effective than others.