Oral corticosteroids ( Prednisone , Solu-Medrol ): Acne may be caused by systemic steroid use, but "steroid acne" is usually characterized by an acute eruption of tiny papules and pustules over the chest and back. Oral steroids may play a role in the treatment of cystic acne, not on their own, but as an adjunct to other antibiotic or isotretinoin therapy to try to suppress scarring inflammation in the skin as fast as possible. This may be especially important with the initiation of isotretinoin therapy, and many providers will start low-dose systemic steroids at the start of isotretinoin therapy in order to block the anticipated flare in disease that retinoids may trigger.
Go for Accutane. I had horrific back and chest and shoulder acne and it started going on my face too. Did antibiotics first, then topical retinoids like tretinoin cream, benzoyl peroxide, adapalene, and none of them did the trick. Finally got put on Accutane by my dermatologist at 80 mg a day. Am 3 months in and it's finally going away even though I'm blasting test right now. Really worth it. Only sides I've gotten are really really dry, flaky lips, hair, skin in general, and occasional mild joint pain, but very tolerable overall. Go for it man.