Hi there, my name's Jane and I'm a 24 year old female.  I have been battling acne since I was a teenager.  It started out with some red spots and over time, it has slowly gotten worse to the point where not only is my face always inflammed, but the texture is bumpy and uneven.

I have a feeling my skin is as bad as it is now because of a combination of things: hormones, from picking at my skin, overuse of products, usage of well water as I live in a rural area, and perhaps some sort of fungal thing.  I have similar looking breakouts on my shoulders and some down the rest of my back as well which leads me to believe that it isnt just what I've applied to my facial skin, as I haven't used any products on my shoulders/back except for a few.

I've tried all kinds of products and nothing seems to show any improvement except for 2 (but only minimal improvement): Nizoral (with 1% ketoconazole) and tea tree oil.  The tea tree oil keeps pustules/cysts from getting more angry and keeps more from popping up overnight, but it can only do so much.  My spots are constantly there. The Nizoral is helping with my tiny bumps, but not with the other types of pimples I have. (I'm thinking these tiny bumps could either be closed comedones or pityrosporum folliculitis?) 

I'm going to be starting birth control for the first time within the next few weeks (contains estrogen and progestin) so I'm interested to see if that helps.  I'm going to see a dermatologist soon, but my insurance is not the best so I'm afraid they won't really try to understand, they'll just try to prescribe me something based off of past cases. From what I've seen and read online, acne is better dealt with internally when nothing seems to work.

My blemishes have always bothered me, but as I grow older I find myself becoming more emotionally and psychologically damaged from it.  I feel ugly and dirty, invalid, unhealthy, and unworthy of attention.  I'm extremely fearful of exposing my skin.   I just started a new relationship with a guy that I really like (we've been together almost 3 months) and I'm afraid that he will leave one day because of it.  I don't want to go to work sometimes and I don't have a lot of friends because I don't want anyone to see my skin (which keeps me from being too social). I have half a closet of clothes I've never worn because of the spots on my shoulders/back.  It's been years since I've gone swimming or slept over someone's house. I try to always wear makeup unless I'm at home with my parents. I mean, you can still see the uneven texture of my skin through the makeup, but it's better than having my face look as red as it is. It's at the point now where I just want to stay home until my skin clears up, but obviously that's impossible.

I'm just here to ask if anyone has any insight on to what type of acne I really do have and if there's anything they suggest to help me clear my skin?  Thank you in advance.