Hi , thanks for posting your query

I can understand your anxiety for severe acne.
going through the above mentioned details of treatment , you can be started on hormonal therapy for acne, to be started under doctor's prescription

the following may be used
-Spirolactone 50-200mg per day
-Cyproterone acetate 50-100mg per day
-oral contraceptives like Diane35 (from day 1 of menstrual cycle) or Yasmin(from day 1or day 5)

I suggest you to start diane35 in addition to oral azithromycin .
It can take up to three months to see improvement.
spironolactone can be added if the response is inadequate.
As the acne clears Azithromycin can be discontinued.
Diane35 , with topical retinoids, can be continued as maintenance therapy

regular exercise ,avoidance of stress will give added benefit

Hope this helps you

Hi Atiqa,
Nodulocystic acne is severe grade acne and is difficult to treat. Also your problem has been compounded by PCOD.
in your case to treat acne, these points should be kept in consideration
Firstly oral isotretinoin is given in dosage of 0.5 to 1 mg/ kg body weight per day and it should be given till cumulative dose of 120 mg/ kg body weight is attained . This decreases further recurrence of the disease
Oral antibiotics can be combined to reduce inflammatory lesions
Cysts and nodules can be treated by injecting intralesional steroids with or without intralesional antibiotics
As you have PCOD, a course of oral contraceptives should be given apart from metformin to improve acne

Apart from these, as a general skin care routine in acne
Use a salicylic acid based face wash twice in a day
Get your comedones extracted regularly
Apply benzoyl peroxide gel in morning and retino a cream in night over acne lesions
Do not squeeze acne lesions
Avoid refined carbohydrates and dairy products as these can aggravate acne
Take healthy nutritious diet
Do not get facials or massages done over face and do not use oily cosmetics.

Hope that helps