I dont know what to do anymore this is a nightmare. The picture that i added is nothing compared to what ive been through, it all started back in senior year of high school, i was 17 and now im 22, male. It killed my self esteem completely, it was also the mask period at the time so i guess i could hide it, i noticed it begin after i started doing "No fap", it was terrible all these years and yes i have tried stopping but still no change. A year ago i started isotretinoin and the effects were terrible, also now knowing that i might have permenent damage is even more frustrating, anyway my acne went away after 8 months and the clear skin lasted for about 2 months. Now its back and its not the same since, it used to be cystic acne and now its just pustules and they are so annoying, they mostly accure around the mouth and nose area, i also notice these breakouts happen at the same time and usually at the exact same spots, i have had insomnia for the last 5 years, i have tried so many different diets(currently on the semi carnivore/keto diet, since i eat some fruits maybe like 1 per week), please help me i dont know what to do anymore i have tried feeding the gut bacteria or whatever with probiotics and stuff, could this be caused from my terrible childhood diet?(Sugar, proccessed junk, some antibiotics here and there) i dont know, tho it definitely feels hormonal, i would be grateful to hear your thoughts and perhaps answer any questions, thank you!