Hello and welcome to healthcaremagic Cystic acne is a clear cut indication for oral retinoids e.g Isotretinoin. Oral retinoids are the most effective drugs for acne and are usually first choice in severe or moderately severe acne OR acne not responding adequately to traditional antiacne medications OR acne significantly affecting the quality of life of patients regardless of severity. Besides oral retinoids topicals like benzoyl peroxide and clindamycin gel should also be used. Oral antibiotics like Azithromycin may also be started to bring about rapid control of the inflammatory acne and also as a prophylaxis to possible flare that may happen during the first few weeks of therapy with retinoids. Hope this helps Regards