The consultant dermatologist on this had some useful advice on the different types of acne and treatment. You'll need a pen and paper.Likely roaccutane, yes.
If you can, I would give it a shot to visit an aesthetician that specializes in skin barrier health (mine does, I'd try to look for a salon that uses Reviderm, they seem to have people specializing in it), as they can help with gentle extractions to help against more cystic breakouts and also to help your skin through the roaccutane, it's not joke unfortunately that it is really hard on the skin as well.
She also made me think more carefully about using skincare products.
I nearly got put on Roaccutane and I'm glad I didn't go on it after the effect it had on a sibling.
As I said before the things that sorted mine were zinc tablets and AHA's in a cream.