Severe nodulocystic acne

Severe nodulocystic acne virtually always requires Accutane to bring and keep it under control. Theoretically, the previously shown regimen of using an oral antibiotic, a topical antibacterial, and a comedolytic (Retin-A) should be used first, but rarely is this successful. I trained in the pre-Accutane era, and patients such as this one shown here virtually never responded well to that therapy. It is strongly urged that therapy be tried first, but I often break that rule (with the patient's consent) because I don't want to waste the patient's time and money.