Since your severe acne has resisted standard treatments for three years, the most effective medical option is often oral isotretinoin, a prescription retinoid that targets all major causes of acne. Other systemic options include oral antibiotics like doxycycline, combined with topical retinoids (such as adapalene) or benzoyl peroxide. If hormonal fluctuations are a factor, oral contraceptives or spironolactone may be recommended. Dermatological procedures like chemical peels can also help. Because treatments like isotretinoin require close supervision and laboratory monitoring, please consult a dermatologist. They will design a safe, highly effective personalized treatment plan to help clear your skin.