Hi, Thanks for writing to us. Isotretinoin is considered to be the drug of choice for nodulocystic acne. The standard dosing is in the range of 0.5 to 1 mg/ kg body weight per day. If you are having just one or two cystic lesions, your doctor might be right in keeping the dose constant. However if most of the lesions are cystic then dose should definitely be increased. Initially when patient is started on isotretinoin a flare of acne is not uncommon and that is why many prefer to add oral antibiotic with isotretinoin initially. Cystic inflammed lesions of acne can also be settled by injecting a corticosteroid and antibiotic combination( triamcinolone and lincomycin) intralesionally in the cyst. The personal opinion of dermatologists may vary and hence I would like you to stick to your doctor s prescription as whatever she has prescribed is after a thorough skin examination. Take care.