I have a kind of acne that gets better in the summer and worse in the winter. These are usually under the skin bumps around my jawline, and lower face, but I also regularly get them anywhere else on the face. They stay inflamed for like 2 weeks, and then the hyperpigmentation stays for months. I also have these tiny bumps primarily on my lower face.

I am 23M. I was on Accutane when I was 19, and it cured my acne for around 6 months until the winter, when I had another wave of acne. Ever since then, in the summers it is manageable (maybe 2 pimples a month), but in the winter it is awful, with constantly having pimples, and they also take a lot longer to heal.

The only way to reduce the number of pimples is by not having my face touch a surface that hasn't been washed, especially with pillows. I change my pillowcase every night, and if I don't change it even one night, I get more pimples. I am also extremely careful with my diet, and have removed foods that used to cause acne reactions.

My hypothesis has been that the acne is related to dryness, so I use a gentle cleanser twice a day. I use the Hada Labo urea cream in the morning and at night. Over the last couple nights I have also started wearing a silicone sheet mask to bed to lock in the moisture, and it seems to help a little bit.

In terms of actives, I have tried Malezia's benzoyl peroxide, which is micronized, so it is supposed to be less drying. I left it on for 20-30 minutes and rinsed it off, for about 3 weeks. It did not seem to help, and almost seemed to prolong the pimples. I know the right way is to leave it on overnight and try it for 8 weeks, but I have not continued with it because it did not seem to help and it is drying. But maybe I should go through with it to actually verify if it works.

I also tried a sulfur cream, but only over 3 nights, and it also did not seem to help at all and maybe inflamed the pimples more, so I have stopped it too. Maybe I should continue with that for longer. I am hesitant to continue with these actives if they seem to inflame the pimples or don't seem to cause some benefit because they are drying, and logically they would seem to make my acne worse?

Whenever I have tried tretinoin, it gave me multiple deep pimples overnight, so I have never continued past the first night.

Other actives I am considering in the future: Differin, Epiduo, oral B5, Azelaic acid, Tazarotene

I would rather not take Accutane again 🙁

Has anyone ever dealt with something like this?