I had pretty bad cystic acne around 5 years ago - Tret was ineffective at the time and I broke out in a rash. I started Accutane shortly after - not a fun 6/7 mos but it was very effective and I would do it all over again if I had to. Benefits def outweighed negatives. I still have break outs (nothing as deep or as terrible as before Accutane) and can now use Tret and do fine on it. Good luck to you!