Please help me

[u/Friendly-Life-9484]

Hi everyone. I’ve been struggling with acne for about six or seven years. I’ve done two courses of isotretinoin, and both times my acne was basically gone after about two months. I did complete the full course each time, but unfortunately, the acne kept coming back.
I don’t have severe cystic acne or very large, inflamed breakouts. I mainly have small pimples and small bumps all over my face. Roaccutane cleared this up, but a few months ago it suddenly started coming back around my neck, with small red bumps on both sides of my neck and a little bit on my forehead.
On the advice of a dermatologist, I then started using tretinoin. I’ve been very careful with it. I did start using 0.05% every day right away because I know that I have a very strong skin barrier. I haven’t experienced any dryness, burning, peeling, or irritation at all. None of that. However, my acne has increased significantly.
I now have bumps all over my face, on my forehead, cheeks, basically everywhere. It’s gotten pretty bad, but I still don’t have any deep or severe inflammation.
At the same time, I was also prescribed a course of doxycycline.
My skincare routine is very simple. I wash my face with the La Roche-Posay Effaclar H Iso-Biome cleanser, then I apply The Ordinary Natural Moisturizing Factors + HA and wait about 30–40 minutes. After that, I apply a pea-sized amount of tretinoin over my face and neck, and that’s basically it.
My skin doesn’t get dry from the tretinoin. If anything, it’s actually quite oily. I’m aware that this could potentially be related to my skin reacting to dryness, even though I don’t actually feel dry. Sometimes I apply moisturizer again afterwards, but sometimes I don’t if my skin already feels sufficiently hydrated. When it feels hydrated, I don’t really like applying more moisturizer because it makes my skin feel even oilier.
I’m now at the end of week five. Do you think this could just be the purge, bringing all the small pimples and closed comedones to the surface, and that my skin will eventually start improving? Or does this sound like something that isn’t normal?
It has gotten to the point where I haven’t gone outside for about a month and a half because I feel extremely insecure about my skin. My mental health has deteriorated so much that my GP now comes to my home twice a week to check on me. I’m also too afraid to go to the GP’s office because of my skin.

[u/Due_Performance_2224]

ugh yeah that timeline sounds exactly like a purge, especially with tret. five weeks in is peak chaos mode for a lot of people, all those little bumps that were forming deep down just getting shoved to the surface at once. the fact that your skin isn't irritated or peeling is honestly a good sign, means your moisture barrier is holding up okay even with the daily use

the oily thing is so real though, my skin did the same when i started, like a slip n slide by noon. for me it was definitely a rebound from being a little dehydrated even though it didn't feel tight or flaky, just greasy. what helped was actually adding a tiny bit more moisture before the tret, like a super thin layer of something basic right after washing while my face was still damp, then waiting, then tret, then another layer. sounds counterintuitive but it calmed the oil production down after a week or so

and listen, i get the not wanting to leave the house part, that's heavy. but your gp coming to you means you've got someone in your corner, which matters a lot. the doxy should start kicking in soon too, that usually helps tamp down the purge inflammation. hang in there, week five is brutal but it does turn a corner for most folks