Acne is the most common skin disease, affecting up to 95% of adolescents. Severe episodes of acne can cause considerable physical and psychological scarring. All forms of severe acne require systemic treatment.
The available options include oral antibiotics, hormonal antiandrogens for female patients and oral isotretinoin, as well as combination treatments. Oral isotretinoin is the only drug available that affects all four pathogenic factors of acne, the first of which is excess sebum production. This may explain why it is so effective. A dose of 0.5–1.0 mg/kg/day of isotretinoin dramatically reduces sebum excretion by the order of 90% within 6 weeks (Dermatoendocrinol. 2009 May-Jun; 1(3): 162–169.).
Studies have been done on changes in long-term oil production following isotretinoin therapy. In one study published, sebum production was measured in patients in whom isotretinoin had been discontinued for at least 20 weeks. A 30% to 80% reduction in sebaceous gland activity was still present for as long as 80 weeks in some subjects (J Am Acad Dermatol.).
There are other options, like you enquired about, to reduce facial sebum production and help in acne.
The hormonal antiandrogens, Oral contraceptive pills and spironolactone, also target factors affecting sebum production in the skin. You may speak to your doctor to find out if you are suitable for these, as I noticed you mentioned you have tried antibiotics and topicals but not any of these treatments.
A few of the more studied topical compounds include topical 2% niacinamide (study in 100 subjects showed lowered sebum excretion after 2 and 4 weeks of use), topical 3% green tea emulsion, and topical 2% L-carnitine. Certain procedures such as chemical peels and lasers can also help.
However, acne is a complex interplay of factors; aside from excess sebum production, comedogenesis (formation of blackheads/whiteheads), P. acnes bacteria and inflammation are other factors to be controlled to achieve successful treatment of your acne. I would suggest you follow up with your doctor to discuss your concerns regarding isotretinoin therapy and your options.
