Hello. Thanks for writing to us at healthcaremagic Cystic type of acne is considered to be severe grade acne vulgaris. Oral Retinoids i.e Isotretinoin is the drug of choice for severe cystic acne. They bring about the most rapid control in Nodulocystic type of acne. Moreover,Oral Retinoids are also preferred for long standing acne such as in your case. Oral retinoids are prescription drugs. Testing for Liver enzymes and Serum Lipid profile at baseline and at 1 month of treatment with Oral Retinoids is routinely performed while on therapy with Oral retinoids. Usually I also start my patients on Oral antibiotics along with Oral Retinoids. Azithromycin can be safely combined with Oral retinoids. Topical treatment is part of the overall treatment of acne and adds to the the overall response. Topical Benzoyl peroxide gel can be used twice daily for active acne lesions. I would suggest that you seek an appointment with a dermatologist in your region for the needful. Regards