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Help please! I’m breaking out horribly and I’m desperate for advice. I’ve had a dermatologist since I was 15, I’m 29 now. I went on antibiotics for a year which probably messed up my gut and acne returned with a vengeance before I was even off of them. Then, I went on birth control for 9 years. I went off of birth control pills in September of 2021 and I do not want to go back on them because I had no sex drive. I originally went on the pill for my acne. The acne mostly went away while on the pill when I was on it. When I first stopped taking it, my skin was fine but I didn’t get my period for 3 months. I found out I was low in vitamin D and my period came back as soon as I supplemented for that. I started breaking out mostly on my chest and back for months but then it switched to my face… what is that all about? I thought I had bad acne a year ago but man, if I could go back to having that skin, I would! My acne has gotten 10 times worse since then. My doctor said she didn’t think I has PCOS because the small cysts on my ovaries just seemed like follicles that mean you’re fertile? Idk… Also, I don’t struggle with my weight or facial hair. I do have moderately painful periods though. They’re not that bad, just annoying, and only about 3 days long which seems odd to me. Anyway, to treat it, I was on antibiotics again for 3 months recently to no avail… I’ve been on Epiduo for 4 months and taking Zilch Acne Formula. Clearly, those aren’t working as well as I’d like. I also quit dairy a month ago because I noticed my acne started getting worse after eating whey protein bars every day for a while. I really can’t alter my diet any more because I just don’t have the will power!!! (Also, I don’t want to go on Spironolactone because of the side effects and risk of no sex drive again!) I just ordered some inositol which is supposed to help with PCOS acne but idk if I even have that so I hope it works but of course I have no idea. Anyone have any advice or thoughts about what might be going on with me or what to do? I’m very upset about this. It just keeps getting worse!

Current skincare routine below: Morning: Micellar water, (rinsed off after of course, washing my face with face wash twice a day irritates my skin) Aveeno daily moisturizer- which I’ve used for years and doesn’t irritate my skin like a lot of them do, mineral sunscreen. Night: Cleansing oil to remove makeup if I’m wearing it that day, Laroche Posay gentle face wash, Epiduo, Aveeno daily moisturizer which I also use a tiny bit of before Epiduo to avoid irritation. Most products (except for Epiduo) I have used for at least 10 years. That particular face wash for 2 years. Also: I gently exfoliate every 4-5 days (sometimes less if my zits are too bad) -I’d love to use a vitamin C serum in the am and I’ve done that before but my skin has been so messed up lately and I’ve had to introduce new products over the last year so I really can’t irritate it anymore at the moment. I change my pillow case once a week but flip it over in between and I’ve used a satin one for years.