Here's the deal- I dealt with acne before and after PCOS diagnosis and here is the best.stuff.ever.
I am a beauty blogger so I get massive samples of both cheap and super expensive products and here is the cocktail that cleared my skin.
Clindamycin- topical anti-biotic gel that soothes infected, cystic skin and will NOT affect BCP's the way that oral antibiotics do. It is healthier if you are worried about antibiotic resistance. (prescription)
Differin- the retinoid that helps skin exfoliate more evenly, a vitamin A derivative. (prescription)
CeraVe hydrating cleanser- water soluble cleanser that hydrates skin, good thing cause I live in Colorado.
CeraVe moisturizing lotion-non comedogenic, no fragrance, no irritants.
Proactiv Repairing Lotion- good benzoyl peroxide content, nice texture, you can use this without the other Proactiv products, this is what really clears your skin since the medication is not washed off, as would be in the cleanser.
I've had reasonably good luck with Paula's Choice (www.paulaschoice.com) and Mario Badescu (www.mariobadescu.com) products, but what has really cleared my skin up is taking 1,000mg of metformin a day. Also, Retin-A works well to fade the acne scarring. Just my .2 cents worth of info...
My doctor told me my cystic acne was a result of my PCOS and metformin would help it. It has a little bit. I dont get the cystic pimples as much (I dont take the met like I should) but I no longer get it on other parts of my body. I need to try some of those that you mentioned now that my hormones are under control. Good post
I've had cystic acne for about 20 years now. Terrible scarring because of it too.
The only thing that has EVER worked for my skin--for the boils, facial acne, oil control, etc. is Aldactone/Spironolactone. Not Metformin. Just Aldactone. Cutting out the excess carbs/sugars helped some too, but honestly, the aldactone is the only thing that ever has helped. Now if I could just remember to take it!
__________________ 34 yrs, DH 30
Dx in 2001
Cystic Acne, Hydrenitis Superativa, hirsutism, 80pounds overweight
Spironolactone, Effexor, Provigil Daily
**************************************** God, give me patience but I want it right now!
Do you need a referral to see an endocrinologist? I have really cut back on sugars and carbs but my energy level and acne have not improved - and it's been about 4 months.
Yes, I believe you do need a referal. It is all based on your insurance. Make sure that your primary care or gyn refers you to an endo that has experience in PCOS, and does not send you to a fertility specialist. Thats what happened to me... waste of $30 for the doc to tell me he delt with fertility only.
a word of warning about the Proactiv repairing lotion...make sure you use a moisturizer with it!!! It's really really drying to the skin. I used to work there and girls would come in all the time with super dry skin because 1) They were using wayyyyy more than they should have (use about a nickel size drop) and 2) they were not using a moisturizer.
Don't get me wrong, I love the stuff, I just don't want any of you girls to have the dry, painful skin I saw so much when I worked there.
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I have also had cystic acne. I have found that Yasmin (after a few months) really has helped me so far. The progestogen is similar to spiro so I gues that's why. But I always have one small lump on the side of my face that occasionally swells up, but is like a spot that you can squeeze to get rid of, it is just like a cyst, that I have to very careful with. It is very odd. Tends to swell up when I am run down. I have had it for 7 years now! I should perhaps show a doctor...
Seven Years of Cystic Acne- NOW BETTER. 
