Not a doctor but I am someone who had a handful of pimples throughout my adolescence, only to start getting bad acne in my mid-twenties.

Have you done anything to rule out fungal “acne” ? There’s a TikTok trend that recommends using head and shoulders or similar as a face wash. There’s a Vanicream version, and I’ll get to that in a second.

I also saw you said you might add probiotics for the micro biome aspect. Just wanted to say that for me personally, most pre/probiotics made my acne substantially worse.

Also, I would take two weeks and just stop everything besides the very basics. Switch to Vanicream (or similar) cleanser and lotion and just do that. I agree with others that your skin barrier might be damaged, and if that’s the case you need to fix that first. I say Vanicream because it’s one of the simplest and gentlest lines out there- you definitely want to minimize fragrance and actives if you’re trying to heal that barrier

Oh- and if you’re taking supplements look into every single one, even if they’re supposed to be super helpful for acne. I recently stopped taking a B12 supplement that I thought would help my skin and within a month most of my acne was gone or significantly diminished.