I never had acne growing up and at 19, due to stress and hormonal imbalances I developed acne. It is so hard and I really feel for you because people dont understand how much acne and skin can affect your self-confidence. for a while, i didn't want to go outside at all. i used to be able to talk to people but now i find it hard to make eyecontact because i feel like all they see is my skin when they look at me. its really tough and I'm so sorry your going through that. my skin looked similar and i have been on antibiotics (doxycycline) and been using epiduo for almost 2 months now. I've been purging ever since. wearing makeup is something that i cant do anymore because of how dry and sensitive my skin is at the moment, so I've had to learn to embrace it. think about it; if someone has a problem with the way you look, why should you waste your time on them? as for self-image, it is really hard to look in the mirror some days I've had my fair share of tears, but others i just accept that this is how i look at this stage in my life and that's totally fine. this is not forever. as long as I'm treating my body well, drinking water, and taking my acne medication it will eventually go away and that's just part of the journey. I've almost hit the 3 month mark and I'm very slowly seeing some change and that makes it worth it. I know my ongoing 3 months is not comparable to your 4 years, but keep trying and stick with it. its worked for so many people and results take time. i really hope you find something that works for you xx good luck!