From having a look around, I can see there are a number of threads on here already about acne and how everyone treats it, but as someone who has been unfortunate enough to experience very bad acne sides, I'd like to share with you the reason why I think it happens, what the normal treatments are, what I done to get rid of it, and how it all works.

What Causes Acne?

Although there are multiple contributing factors, I believe that AAS-related acne occurs when excess oil (Sebum) is produced by the sebaceous gland at the root of the hair follicle. The Sebum is responsible for carrying dead skin cells through the follicle to the surface of the skin. However, testosterone and other androgens significantly increase Sebum production which leads to blockage and infection.

What Are The Treatments?

Usually a doctor or dermatologist will prescribe some sort of cleanser, or a topical or oral antibiotic.
I personally had some success with topical treatments. One in particular, Duac, done a pretty good job at getting rid of the acne that was there already, but unfortunately didn't do much in the way of preventing it.

In the most extreme cases of acne, a drug called Accutane can be prescribed. There are a few sources on here stock it, but beware, it's not to be toyed with. The only reason I mention it is to warn you to steer well clear - the potential sides are very severe and a very real possibility.

What I Recommend

After trying several diet changes, prescription medicines and soaps, the following is what I've found works best for me. Everyone is different, but there is real science behind this protocol, so I'm sure that at the very least you will see a reasonable improvement! Before I started this regime, nothing I tried seemed to prevent the acne from occurring, nor get rid of it once it was there.

1. Vitamin B5 (Pantothenic Acid)

First up is Vitamin B5, also known as Pantothenic Acid. Amongst its many other benefits, Vitamin B5 is a major part of Co-Enzyme A which is used for fatty acid oxidation at cellular level. A CoA deficiency slows the oxidisation of fatty acids which results in the skin becoming more oily, leading to acne. Supplementing with large amounts of B5 increases the amount of CoA available. The more CoA available, the more fatty acids can be metabolised, meaning they're oxidized or burned as energy.

The study bellow shows that Dr Leung gave his patients 5-10 grams of Pantothenic Acid per day, both of which showed positive results. I've used and would recommend starting at a lower dose of 3-5 grams per day while adding in L-Carnitine (see no.2 bellow).

Source: Lit-Hung Leung (1997)

An interesting side note regarding B5 and CoA; a Vitamin B5 deficiency can result in adrenal failure, meaning an inability to synthesise steroidal hormones, like Cortisol.

Source: Adrenal Fatigue by Jeffery Dach MD

2. L-Carnitine

I include L-Carnitine here simply because it allows for the Vitamin B5 dose to be lowered to a much more comfortable number.

According to the biochemisty of fatty acid oxidation, "Transport is RATE LIMITING STEP for oxidation of long chain fatty acids." (From USD Biochemisty Lecture)

"Carnitine transports long-chain acyl groups from fatty acids into the mitochondrial matrix, so that they can be broken down through ß-oxidation to acetate to obtain usable energy via the citric acid cycle." (Quoted from Wikipedia).

I obtained the desired results from 750mg L-Carnitine per day. An added benefit of the combo is smaller pore size and smoother skin.

3. Zinc

From my research, the way in which Zinc works for acne seems unclear, but it's believed that it likely heals acne by carrying vitamin A to the skin and regulating the body's hormonal balance.

Source: Cellular zinc fluxes and the regulation of apoptosis/gene-directed cell death

Quote from Clear Skin Forever: "a recent study found that zinc facilitates apoptosis, or pre-programmed cell death, which is a natural part of your skin renewing itself. If apoptosis is delayed, as in the case of zinc deficiency, skin cells stick together instead of dying and sloughing off like they should, which leads to clogged pores. (Interesting fact: isotretinoin, the active ingredient in Accutane, also uses this mechanism of cell apoptosis to treat acne"

Zinc Picolinate is believed to be the most easily absorbed form of Zinc. I recommend 50mg daily, split into two doses.

Other Recommendations

Besides the above protocol, I've found these to be extremely effective as well.

1. Tanning

Anyone who's had trouble with acne and used sunbeds will tell you how much of a difference tanning has made to their skin! As a teenager and into my early twenties, I had some trouble with my skin, nothing too drastic but always an issue for a number of years, until I started tanning that is. No need to go overboard, once or twice a week works wonders. Just make sure to use a decent moisturiser, something with Hyaluronic Acid in it. A light moisturiser or serum works best. I recommend THESE PRODUCTS - the ingredients they use are top notch - I've never seen anyone able to offer what they can at those prices!

2. African Black Soap

A lot of people, myself included, have had great results with African black soap. As well being able to clear acne up on its own, it's known to be effective at treating other skin conditions due to its healing properties. I'd recommend buying a product that has added natural Shea Butter and Aloe such as THIS. The soap is quite drying, so make sure you have a decent moisturiser on hand as mentioned above.

Other Proven Treatments

Although I haven't had any direct experience with the following, I'm including them here due to the large number success stories of their use in treating acne, with the science to back it.

1. Chromium

Chromium supplementation on its own has been shown to be effective in treating acne, to a great extent in some cases - particularly in those who consume large amounts of sugar. Epidemiological studies suggest that low glycemic diets are protective against acne and one open label trial found that 400 mcg of chromium improves acne.

Source: McCarty M. High-chromium yeast for acne? Med Hypotheses. 1984;14:307–10.

Some anecdotal evidence shows doses of 600mcg to be effective.

2. Retinol Vitamin A

"Vitamin A acid represents the most effective therapeutic agent available for the topical treatment of acne vulgaris. This is also borne out by the results obtained in 152 patients over a two-year period. Clinical improvement is striking, long lasting remissions can be maintained by continuous treatment, and there appears to be an acceleration of the natural course to spontaneous remission of disease activity."

Source: Treatment of acne vulgaris using vitamin A acid

Hope this helps some of you as much as it has me!