Alright so I posted about this about a month ago, and no one seemed to understand what I was saying except one person, who suggested I use a retinol.

As a general history, I have had hormonal acne that started when I was 15. Nothing helped - not even birth control pills, birth control patches, or the IUD. I still struggle with it to a point now at 36, but it's gotten a lot better since taking Accutane twice and then starting Spironolactone. I don't have cysts anymore, but I do get pimples more than I should. I also have milia, blackheads, pores that fill up (not SF, I've looked into it), scarring, and uneven skin tone. Because of that, I decided to upgrade my skin care game a second time about 6 months ago. And I haven't seen any improvement at all.

Current Routine:

AM:

• The Ordinary Hyaluronic acid
• The Ordinary Niacinamide
• Benton Snail Bee High Content Moisturizer
• Coppertone Pure & Simple sunscreen

PM:

• Softymo Speedy Oil Cleanser
• Cetaphil Gentle Skin Cleanser
• The Ordinary Hyaluronic acid
• The Ordinary Niacinamide
• The Ordinary Mandelic Acid
• Benton Snail Bee High Content Moisturizer

One day a week:* The Ordinary Peeling Solution (literally does nothing)

I also do other things like use a silk pillowcase (that I wash regularly in hot water), avoid picking, avoid products with alcohols, avoid touching or leaning on my face, avoid dietary irritants, avoid "natural remedies" like baking soda and water, etc. The above routine has been my routine for about 6 months. Except I increased my dose of Spironolactone about 2 months ago. But my skin has remained totally unchanged from the start. My skin is acting like I wash my face with air for all the good it's doing. I'm getting sick of doing all this work for my skin and seeing no change at all. And to be honest, that's how it's almost always been.

So maybe a retinol IS what I need? I could ask my endocrinologist for a Retin-A Micro prescription, and with indigent care, it would only cost me $5. I don't know what I need to do at this point, though, and how expensive it's going to be.

So what do I do?

Edit for clarification: I have been off Accutane for many years. I took my last pill back n 2009-ish, then was on a low dose of Spironolactone for 2 years (restarted a year or so ago). My skin has been in its current state since then.