Help! Cluster of acne...

[CantChoose]

Hi,
I am 30 and have had two courses of roaccutane in the past. The dermatologist offered to extend the course beyond the usual or to continue a very low dose for prevention but I want to have a baby and the appointments are monthly, always last minute and mean I have to cancel 18 of my own patients to attend (I am a gp)
Unfortunately, though better than before, it has returned. It is worst on my jawline and the underside of my chin. They are almost all painful, under the skin ones. They very rarely have a head.
The main issue is that for the last few months the right side has been not too bad but there's a 3x3cm patch on the left that is AWFUL. They're raised, painful and there are so many of them in such a small space. It's like they are spreading from each other, is that possible?!? I have tried washing my brushes more often and changing my pillowcase every two days.
As a GP I am aware of medical solutions but am TTC so would really appreciate it if anyone knows anything non-medical that might help!
Its so bad that I'm tempted to stop TTC and just make the decision not to have children so I can go back on roaccutane :(
They're so painful, itchy and of course unsightly. It's really making me miserable.

As a PP said pregnancy and breastfeeding reduces acne (I assume because the increased oestrogen decreases the testosterone that causes acne?!)

Ibuprofen helps reduce the inflammation and pain. I find taking regularly when I have an inflamed patch of acne can help reduce it quicker. Not sure if ok to take when ttc?It sounds like the inflammation is causing the spread of acne so it’s best to focus on minimising this. Ice packs can help too. As a GP I’m sure you’re probably aware that topical meds aren’t the best at treating this type of acne as the actual problem and infection is deep under the skin. However prevention routes I would suggest are azelaic acid and possibly a bha lotion. Have you tried azelaic acid before? It’s safe in pregnancy.

Aloe Vera gel straight from the leave can help a lot with soothing the surface of the skin. I have a plant in my bathroom and chop bits off when I need.

Lastly have you been tested for PCOS? Or any other hormonal imbalance. Might help to understand what hormones are out of whack so you can treat appropriately.

Spearmint tea is an androgen blocker. (Not peppermint). For some people it works great. But not sure how safe it is in pregnancy.

Some people swear by cutting out dairy. I’ve tried this and it made no
difference to mine.

It feels odd advising a gp to do this but have you considered allergy’s? My sulphite allergy causes red spots that don’t come to a head but itch, sting and are neon red. My milk allergy causes jaw line spots too but is more classic rash.

I use an led mask off Amazon, it’s made by beauty star and has over 100 led lights. Very effective. It was £50 or so.

The ordinary salicylic acid is very good at alleviating inflammation, you can put a few drops all over your face twice a day.

I'm guessing you have already done the obvious with skincare.

But just in case you haven't, Paula's Choice products were amazing for my skin. The 2% BHA product really is the market leader for salicylic acid and made a massive difference.

Also Boots are now stocking Cerave moisturiser - oil-free, niacinamide for spots and lots of ceramides. It's a lovely product.

Salicylic acid lotion
It both helps shift clogged pores
And as it is aspirin it massively reduces redness

I use neutrogena face wash and Vichy normaderm toner
Both contain it and it is non irritating
Good luck
I’d also check the spf you are using as they are super hydrophobic and tend to clog pores