How to I treat hormonal acne cysts?

Question: I have mild to moderate acne. I've had it since I was in my teens. I get a couple of cysts each month, usually as soon as my period is done. I've been on several antibiotics in the past, as well as a a myriad of topicals including sulfacet, differin, retin-a, emgel, benzoyl peroxide, and tea-tree oil. I have been taking bactrim for about seven months now. It has not stopped the monthly cysts. I have had injections to help with this, but they take months to completely fade. I even started spironolactone about seven weeks ago but I still get a cyst each month. Any advice or suggestions you can give me will be greatly appreciated.

Dr. Schultz: Thank you for the very detailed information. Clearly your type of cysts require internal treatment as they are triggered by your hormones. When hormonally caused cysts fail to respond completely to antibiotics then the two treatments available are: (1) Birth control pills (even thought one doesn't need them for contraception), and (2) Accutane. In the situation where one doesn't need contraception, I recommend Accutane. For more information, see our episodes on Accutane and Treating Cystic Acne.