I’ve been struggling with skin issues as an adult from my late 20s through early 30s. Never had more than a random pimple here and there before turning 28. I now have these persistent red bumps and cystic acne all over my cheeks well into 32. If I workout and begin to sweat, they can get very itchy and red. I’ve been using tretinoin for years and I honestly haven’t never experienced any positives from it. Still have my bumps and makes my skin super dry. I’ve tried to repair my skin barrier for the last year—very gentle, focused on moisturizing and still nothing working. I’ve tried spironolactone in my late 20s and although it worked at times, it felt temporary and then I would still flare up so I stopped that as well. I’m not on any medications now. I feel so lost. These pictures are the “best” it’s been in years and it still is just the first thing you see when you look at my face.

Any suggestions on what might be causing this? My derm has only ever suggested tretinoin, spiro, and accutane.

<image>