How to manage persistent acne?

Hello doctor,

I am a 24-year-old female. I have been suffering from acne for the last 12 years. My periods started at the age of 12, and I started getting acne at 13. I have oily, dehydrated, sensitive skin. I sweat a lot, especially my face. Even the skin under my eyes sweats too. I can never put on makeup because of the sweat. My face has acne almost all the time. But the amount always increases a week before my period. My periods are regular. I get pretty much every type of acne. But the most painful are the big cysts and nodules. My chin is always filled with 2/3 nodules. My cheeks are filled with cystic acne. My forehead is filled with pustules and papules. I get them even under my eyebrows. I have body acne, too. My back is full of whiteheads. I cannot sleep on the pillow sometimes because the acne on my face is so painful, and it hurts when touched. In the morning, when I wash my face, some pimples burst, and my fingers are full of pus and blood.

I sometimes apply ice on them to reduce the pain. I went to the dermatologist many times. He gave me Azithromycin, Clindamycin, Tretinoin 0.25 %, Azelaic acid creams to use, and Salicylic acid 2 % once a week for 15 minutes to use. I followed the prescription properly. That medicine helped me to heal the acne fast. But they did not stop them from coming. I am so tired of treating them every day. But they never stop coming back.

I do not have a good dermatologist around me. So, I cannot consult anyone. I heard about Isotretinoin. But I cannot take that as it is a prescribed medicine. My sister's acne was cured by it. She also suffered from severe acne. Is it a genetic problem? But neither our parents nor grandparents have it. I have been suffering so much for such a long time. I feel hopeless. Is there anything left for me to do? What should I do to cure my skin? Please help.

Thanks.