Please do not respond with judgement or criticism - it isn't needed or wanted! If you have personally suffered or have a loved one who has dealt with the emotional and physical issues with severe acne, then you will have compassion. My daughter had typical mild (VERY mild) pimples here and there upon entry and through her plebe summer and first year, more flare ups. We all thought with better self care and changes in diet, rest, and hormone balance things would self resolve. They have not. Things have spread and worsened. She's fortunate that some of it she can now "cover up", but the emotional toll and physical (some of the nodular ones she gets really are very painful) have affected her a great deal. On one visit last year to the BMU she tested the waters and asked if isotretinoin would ever be considered, but seemed to hear it was unlikely. I think it's in the formulary, but not 100% sure of that. Yes - she's tried topicals and retinoids and about every product under the sun and bc pills all to no avail. She wants the emotional and physical freedom from this prior to commissioning and finds it all so embarrassing. To her credit she has kept a positive attitude for the most part, but I really see the toll. When home she had a slight improvement, but it clearly is the type of acne (deep under the skin) that is only going to really get clear with a course of isotretinoin. She is NOT one to do anything out of process and I just don't know if any of you have any advice or positive comments that BMU WOULD prescribe this? Again, please don't judge and dismiss this or berate me for the post - whether male or female this stuff affects a young adult. Thank you in advance.