Hello. Thank you for writing to us at healthcaremagic For Moderately severe inflammatory acne as well as cystic acne, my first choice in my patients is Oral Retinoids i.e Isotretinoin. Isotretinoin are the most effective antiacne drugs against moderate to severe grade of acne. They are Sebostatic, Antiinflammatory as well as comedolytic; therefore targets acne at multiple targets. Besides Oral Retinoids, For active acne that is inflammatory, I usually suggest Oral Antibiotics too in my patients either alone or in combination with Oral Retinoids. Oral antibiotics e.g Doxycycline, Lymecycline Or Azithromycin are antiinflammatory as well as antibacterial in action and therefore bring about faster relief in inflammatory acne as compared to topical treatment alone. However, Doxycycline and Lymecycline are not suitable for Oral administration along with Oral Retinoids because of the risk of headache and blurred vision due to increased intracranial tension; Azithromycin is suitable for combining with Oral Retinoids. Topical antiacne treatment is part of the overall treatment of acne and includes Topical antibacterials like clindamycin, nadifloxacin; Topical Benzoyl peroxide and Topical Retinoids. I suggest you to visit a dermatologist in your region. Your dermatologist will assess the severity of your acne and prescribe accordingly. Regards