Ortho tri cyclen was the first pill I went on. It gave me cystic acne and acne on my neck too. This could have been attributed to starting a pill for the first time, i don't know. I did stay on it for a year, eventually the cystic acne died down a bit, but i wasn't overall pleased with the effect it had on my acne, so I switched to Diane 35. This pill didn't break me out any more than before, and it helped probably 25% more than OTC. However, I still get zits every day and it seems i have developed bad chest acne on this particular pill. So, again, I'm switching to Alesse. I hope that will work.