For persistent, widespread acne on the face, chest, and back that has resisted treatment for ten years, oral isotretinoin is often the most effective, definitive solution. It targets all major causes of acne and can provide long-term clearance. Other prescription options include high-strength topical retinoids (such as tretinoin or adapalene) combined with benzoyl peroxide. Oral antibiotics like doxycycline may also be used temporarily. Because your acne is resistant, I highly recommend consulting a dermatologist to discuss whether isotretinoin or a tailored combination therapy is right for you, as these offer excellent, lasting results under medical supervision.