Mid/late-20's female - My acne curse started as just a few superficial pustules around the smile line on the left side of my face in January 2023. I had been using azelaic acid 15% gel in the morning and tretinoin .05% cream for a few years beforehand, along with some benzoyl peroxide 10% face wash daily and spot treatment when necessary. After first noticing the breakout, I coincidentally stopped taking hormonal birth control and have been off since, but I'm not sure if that is related. Note I had bloodwork done for PCOS parameters in June 2023, which came back within normal ranges for the entire panel.

As the months went on, the small superficial pustules started to spread and became more numerous, but were still limited to the left side of my face (which is the side I sleep on). They would pop up within 12 hours or less, quite a few of them in the same smile line spot. I was prescribed Ketoconazle 2% cream and Sodium Sulfacetimide 10% wash in the spring of 2023, which only marginally helped but the breakouts persisted, I barely noticed a difference.

I got a second opinion in late spring 2023 and was prescribed metronidazole .75% cream, which I used for about a week but noticed more acne-like breakouts (zits rather than the small pustules). I didn't give that a fair chance and stopped it pretty much instantly.

I continued with the azelaic acid, tret, and sodium sulfacetimide wash over the summer. After getting a microdermabrasion facial in August 2023, my face erupted like never before with these lesions (still predominantly on the left side) and a spot of impetigo on my chin. I applied topical antibiotics to the impetigo lesion and did not take anything oral. Since then, the breakouts got worse and I tried topical clindamycin, which seemed to exacerbate the problem greatly. I instead began applying over the counter triple antibiotic ointment which helped control it for two months or so. But the tiny superficial pustules persisted. If I popped them, it felt like they spread, and even when I didn't pop them, they left me with hyperpigmentation. They have never really itched.

My dermatologist gave me doxycycline over the holidays in December, which I stopped after 10 days due to side effects (dizziness). I felt like the doxy did not really help until I manually extracted most of the pimples, sanitized the area with rubbing alcohol, and washed my face with Hibiclens for a few days (which I have since realized is not a good idea). I was convinced it was gram negative folliculitis, but a swab the derm did came back negative for everything (maybe due to my use of the triple antibiotic).

Days after stopping the doxy and alcohol/Hibiclens routine, my face spiraled OUT OF CONTROL with tiny superficial pustules, pimples, and small bumps all over both cheeks, on my forehead, and even my chest and back started getting tiny pimples (and that didn't happen before).

I just started .01% tret and .75% metro gel this week, along with erythromycin 2% solution. My derm says she thinks its fungal acne (pityrosporum folliculitis). I also just took a 150 mg fluconazole pill (which I only have two does of total) for what I think is the onset of a yeast infection from the doxy, so hope that may help with the acne.

Does anyone have any recommendations? It feels like I've tried everything.