u/supercutecancer

i’ve been dealing with acne for about 3-4 years now. and it fluctuates so much. one minute i have the clearest skin of my life the next it’s the worst thing in the world. i’ve been on tretenoin on and off the first time being on 0.025% for around 6months - 1year and it was the best thing ever cleared my acne and my darkspots i weened off and then we prescribed 0.1% and started using that for about 10 months and it was like it would help the acne but destroy my barrier which caused more acne and it was a loop for months and months and i was still breaking out. i recently switched back to 0.025% this past june, and it’s like im debating on accutane because clearly tretenoin must not be working anymore. It’s draining and i don’t know what to do anymore and everything im getting prescribed seems to not be working. I got clindamycin gel and I feel like that made my acne more inflamed than it did flatten. Is accutane looking like the next move? I’ve heard about this supplement called clearstem thinking about trying that before accutane. But i’m Also on spironolactone, and i was on 50mg for 5 months and then a week ago started taking 100mg. I feel like im out of options i just want clear skin. I attached pictures of how my skin fluctuates.

My routine

Morning
HOCL spray
Azelaic acid (recently upped the dosage a week ago from 10% cream which i’ve been using for a couple months to 20% cream)
Black girl sunscreen 30 spf
cerve healing ointment

Night
Cetaphil gentle facial cleanser + pear soap
HOCL spray
Tretenoin 0.025%
Spironolactone 100mg (just started 100mg a week or two ago been on 50mg for 5 months prior)
Cerve healing ointment Night
Occasionally hydroquinone cream.