Since standard treatments, including isotretinoin, had limited success, your acne may have an underlying hormonal driver. For persistent cases in adult females, oral spironolactone or specific oral contraceptives are highly effective at regulating sebum-stimulating hormones. For topical management, a stronger retinoid like tazarotene can promote deeper skin cell turnover. To address both active breakouts and stubborn pimple marks (hyperpigmentation), topical azelaic acid is an excellent, gentle option. I highly recommend discussing these targeted medical options with your dermatologist, who may also suggest in-office treatments like chemical peels to safely accelerate your results.