I've used Accutane (isotretinoin) for a few months, and never noticed much of a difference. On the other hand, Accutane can have harmful side effects (such as damaging your liver), at least according to my doctor, who had me get regular blood tests (1x per month) while using Accutane.
My experience is much like an earlier poster mentioned - eliminating dairy products (going entirely to fortified soy and rice milk) has helped a lot with the acne, as has a drug called "Benzamycin" which is benzoyl peroxide plus an antibiotic.
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