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Not severe but you have shallow icepicks and PIH or redness that will fade eventually and leave a small scar. Also, ketoconazole shampoo is for fungal issues that could be contributing to acne, or specifically dermatitis like sebbhoric dermatitis. That could also mimick or cause acne related problems if you have dermatitis.
If you're skin gets abnormally bumpy or uneven with weird texture and sensations, and doesn't resemble typical acne, my experience has shown it could be related to something like sebbhoric dermatitis and many doctors misdiagnose it as bacterial.