My family has a history of severe nodular acne. My grandfather, mother, and my siblings all suffered from it.
My brother had it the worst, but I still had it quite bad. I have facial scars from it.
It can be quite traumatic, psychologically. My parents and doctor were reluctant to offer me accutane - so I spent a couple years really suffering, trying all kinds of treatment that had little effect (I believe it was benzyl peroxide -> antibiotics -> some other stuff). I turned into a social recluse, I hated looking at myself in the mirror.
Accutane was the only thing that worked. It was truly a miracle drug for me. I ended up doing two courses as a teenager which knocked it into remission, through my university years.
It came back in my mid 20s moderately, so I tried the benzyl peroxide (the acne.org regimen). But it was a pain to apply regularly, costly, and it stained all my clothes. I could only wear white shirts. After a year of that, I went and did another treatment of accutane and it knocked it out.
I still suffer from mild acne to this day - in my late 30s. I keep it under control with salicylic acid pads, so it's very manageable. I also avoid touching my face/neck, which seems to exacerbate it.
Accutane can have a few reported permanent side effects. One is IBS. I was diagnosed w/ IBS after taking my last course of accutane. It's hard to know if it is the cause or not (my mother also suffers from IBS, so it may be genetic). It sucks, but the acne was far worse and I'll never regret taking accutane. The IBS is relatively mild - only gets bad when I'm stressed.
Treatment used to be much more draconian. In the 40s-70s, doctors would x-ray your face to eliminate severe acne. My high school physics teacher had this done, and unfortunately passed away in his early 50s due to throat cancer (having never smoked in his life).
https://www.hindustantimes.com/columns/that-acne-could-be-a-...
https://jamanetwork.com/journals/jamadermatology/fullarticle...
https://www.ncbi.nlm.nih.gov/pubmed/26373866
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4565837/
I would suggest you try a low-carb (and zero sugar) diet combined with a Zinc supplement, and even a 5,000 IU Vitamin D3 with 100 mcg Vitamin K2 (MK-7) and 200-400mg of Magnesium glycinate daily (high D3 depletes Magnesium) for six months.
It would help if you took a blood test to find out your HbA1C, blood glucose, and 25-OHD levels, just to know where you're at before you start that. Then retake the blood test.
If I'm right with my assumption, your problems are a lot worse than just getting acne, so you will solve a lot of other issues you may already have or are about to have if you follow those recommendations.
Keto-ish diet works very often with the same effectiveness, but is also very hard to pull off.
But it's a hard diet to maintain, both in terms of managing cravings and consumption, and also because we put carbs (corn syrup, et al) into bloody everything. I found cheese/yougart, ketchup, and salad dressings to be the worst offenders.
Cold showers
Washing sheets in hot water every 5 days
Using a mattesss protector
Washing pillows and quilt every few months
Shaving with a disposable razor used once (bic hybrid)
Washing face with sensitive men’s face wash and washcloth washed after one use
Nidrozal anti fungal shampoo applied to face
Flossing nightly
Washing face with water and a washcloth before bed or waking up (depending on when you shower)
Eliminating sugar from diet and basic weights excerise (dumbbells)
I am vegetarian, no sugar. I worked out 3 times a week
I consume dairy in form of curd and cheese. I am lactose tolerant.
Consuming balanced diet and deficient in nothing, according to the latest report but i still get acne.
I've good face cleansing routine involving walnut scrub, alovera gel.
The only thing that worked was roaccutane. After the treatment it slowly comes back so I beat it permanently with low-dosing (a 10 or 20mg pill every now and then)
I realize there must be a reason deep down that caused it. Typically dermatologists first try to give a cleansing treatment with some kind of scrub cream (will solve it if hygiene was the issue). Then they try anti biotics (if bacteria is the issue) then finally use the nuclear option with roaccutane which works with practically every one (but relapse can happen)