there is nothing like suffering sleepless nights on a diet and griding it out every day in the gym on low carbs, only to have an otherwise awesome physique ruined by bad skin. many of us have been there. it's part of the territory in this sport. as a teenager, i was prone to acne, so when i first started using gear, i broke out pretty bad a few times with large cystic bumps. accutane is a great drug but it is quite a commitment and it is very harsh on the body. there are a few things i would try first before going that route. 

first, its important to understand that acne is an infection of the skin. increased oil production from using AAS will make your skin more oily, collecting more dirt and bacteria, making it more likely to clog pours and cause infection. the key is to keep the skin very very clean. that means take showers often. if you have acne, i'd take at least 2 showers a day. use dial anti-bacterial bar soap. if you have existing acne, dont scrub it, as this can spread the infection and damage your skin. use a fresh towl every day. over the counter benzoyl peroxide creams can help to dry existing bumps. short amounts of tanning in the sun or tanning beds can help to dry the skin out as well. just dont over do tanning, as it can increase the amount of scarring from damaged skin. make sure that you change your pillow case every day!!! i use one side of the pillow one night, then flip it over for the next night. the following day, i use a new pillow case. i change my sheets 2x wk and i only wear shirts once before they are washed. this may all sound extreme, but it will make a big difference. once you get acne under control, its a lot easier to stay clear than it is to get clear. 

if you go to a derm, the first route they will try is an antibiotic. usually, they start with the cycline antibiotics and couple that with a topical. if you find that right antibiotic, it can get an infection under control, but that doesnt mean that you are cured. you can still break out again after the meds are discontinued. they will go through several antibiotics before considering accutane, as it is the last option they will use. accutane works by pushing the oil out of your sebaceous glands, which are like like little oil reservoirs under the surface of your skin. over time, it will dry these glads out. after a solid course of accutane, the amount of oil your glands produce, will be greately reduced. accutane can truely be a cure for acne. 

there are down sides though and reasons that MDs use it as the last line of defence. sides effects can be harsh. i would suggest being monitored by your dr while you use this med. they will do blood work every month to make sure your organs are still functioning well. at first, you will notice more oil and more acne, as the gland pushes out all of the oil it contains. then over time it will improve. you'll experience dry and cracked lips and very dry skin, to the point of it being painful. you'll burn easily in the sun and may experience a long list of other sides. in the end though, it will be worth it, if you suffer from acne. i would not suggest running it at the same time as a cycle, if it can be helped and i would NEVER run an oral steroid with accutane. if you choose to get your accutane underground, i would stick with a lower dose, around 20mg EOD and then maybe move to ED, for a total of about 3 months. it would still be a good idea to go in and get some labs done through the cycle.