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I do believe, as all of you have stated, that Accutane is by far, the best form of treatment for cystic acne. I am 43 years old. I didn't have acne as a teenager, but ended up getting it in my early thirties. I have been on and off Accutane for the past 13 years. It does work, however, in my unfortunate circumstance, it always comes back. My doctor tells me that there are a select group of women who don't get acne until they are in their thirties and forties. For many of the adults, 1,2,3, or even 4 courses of Accutane don't work without the acne coming back at some point. For me, I have to take a consistent low dose to keep the acne at bay.