Hello neha, You are currently using nearly all of the medications we have against this disease process. Here is a little more information on your problem. Acne vulgaris is a common skin disease. Acne vulgaris is a common disease and is characterized by noninflammatory, open or closed comedones and by inflammatory papules, pustules, and nodules. Acne vulgaris affects the areas of skin with the densest population of sebaceous follicles; these areas include the face, the upper part of the chest, and the back. Retention hyperkeratosis (excess skin cells are produced while not sloughing off the dead skin cells.) is the first recognized event in the development of acne vulgaris. The exact underlying cause of this over-production of skin cells is not known. Currently, 3 leading hypotheses have been proposed. Puberty increases hormones within the body intiating the acne. Sebum production increases - this causes the oiliness of your skin. Also present is P acnes, an anaerobic organism present in acne lesions. The main underlying cause of acne is a genetic predisposition. The following aggravating factors are recognized: • Cosmetic agents and hair pomades may worsen acne. • Medications that can promote acne development include steroids, lithium, some antiepileptics, and iodides. • Congenital adrenal hyperplasia, polycystic ovary syndrome, and other endocrinological disorders associated with excess androgens may trigger the development of acne vulgaris. Even pregnancy may cause a flare-up. • Mechanical occlusion with headbands, shoulder pads, back packs, or under-wire bras can be aggravating factors • Excessive sunlight may either improve or flare acne. In any case, the ultraviolet exposure ages the skin. Treatment should be directed toward the known pathogenic factors involved in acne. These include follicular hyperproliferation, excess sebum, Propionibacterium acnes (P acnes), and inflammation. You are currently using a retinol cream on your face. Topical retinoids reduce the numbers of microcomedones, comedones, and inflammatory lesions. They may be used alone or in combination with other acne medications. Skin irritation with peeling and redness may be associated with the early use of topical retinoids. The use of mild, nondrying cleansers and noncomedogenic moisturizers may help reduce this irritation. You are also using an antibiotic. Antibiotics are mainly used for their role against Propionibacterium acnes. They may also have anti-inflammatory properties. Benzoyl peroxide products are also effective against P acnes. Some hormonal therapies may be effective in the treatment of acne vulgaris. Oral contraceptives increase sex hormone–binding globulin, resulting in an overall decrease in circulating free testosterone. Combination birth control pills have shown efficacy in the treatment of acne vulgaris. Acne can be a very depressing situation. You appear to be doing all you can to lessen the impact of acne on your life. You are taking all the appropriate medications. Please tell your family physician or dermatologist if you are depressed. They can help. Be well, Dr. Kimberly