Hi.. As you said you are having acne vulgaris with cystic lesions.I would like to say few things about acne.There may be different forms of acne..like white comedones,black comedones,inflammatory acne, conglobet and cystic acne . You hace acne cystica. Acne vulgaris is a multifactorial disease. There may be some cause. Stress,anxiety,oily food,dandruff, sleeplessness, hormonal imbalance,drugs like pills,steroid ..etc may cause or exacerbate the disease. Hereditary factor is also important.Oral drugs along with topical applications might improve the lesions. You consult eminent dermatologist for firm diagnosis and proper treatment. I advise in my patients having acne as below.. - to avoid all suspected factors which stimulate or exacerbate the lesions - tab azithromycine 500 mg thrice a week 24 hourly consecutively for few months Or cap minocycline 50 mg daily in morning. - tab isotretinoin 5 mg daily at night..it may be taken in low dose. So,have low cost and less side effects. - clindamycine gel or adapalene gel to apply at night on lesions only -cleanse the face with antiseptic face wash like acmed. - in cystic lesions, I might give intralesional steroid injections like triamcenolone 10 mg.. Do not stop treatment even after good result.. You must continue treatment for few months to few years to prevent relapse. Have patience as the good result may be there after few months. Be happy and positive.I hope you got my answer. Thanks. Dr. Ilyas Patel MD