There are many different gels and antibiotics to try first. We found that the Epiduo gel was too harsh and made his face redder and irritated. Made it look like it was worse but was actually getting better. We switched to Duac & Differin for the skin treatment with the antibiotic and it seems to be coming along.
I tried multiple antibiotics and in the time that it took me to give them a chance to work, my acne went from terrible to just plain disgusting, and I still have scars all over my face and shoulders to show for it.
I'm curious what your dermatologist cited as reasons for not prescribing it to celiacs?
I was dx with celiac when I was 15, started Accutane right before I turned 18. I'm now almost 21. Just wanted to give you a time frame reference.
Accutane is not a joke. The side effects are real, especially the joint pain. I used to wake up in the middle of the night feeling like my shoulders and hips were on fire. That being said, although the experience was rough, I would not even hesitate in the slightest to do it if I could do it over again. My dermatologist has literally put of thousands of people on Accutane, with 0 extreme complications. The change in your son's life will be well worth the ordeal. People just don't treat you well when you have severe nodular acne.
To give you the other side, I have become more sensitive to certain foods since coming off Accutane. But I don't know if this is causation or correlation. About 4 months after I finished Accutane (and they say it stays in your system and continues working for months after you stop the actual pills), I started having weird stomach issues. I did a colonoscopy/endoscopy and they found one abnormal biopsy consistent with Crohn's Disease. They later retracted the diagnosis and said it was an immune response to an infection that had been cleared.
So basically, I think Accutane was one of the best decisions I ever made. My mother believes it gave me Crohn's and arthritis (I had hip surgery last year, but I think that was because I had a longstanding running injury from cross country). But the fact that people aren't afraid to look at me anymore, the fact that no one turns away in disgust when they see mountains of hardened pus spewing all over my face under 2 inches of makeup, is worth it to me. Combine that with the fact that it has been proven that people discriminate against prospective job candidates with bad skin during interviews, and it is a risk worth taking in my opinion.
Hope this helps you somewhat. Feel free to ask me more if you want to hear more from a teenager's perspective.