Hello and welcome to healthcaremagic For severe acne OR for acne unresponsive to traditional anti-acne medications, Isotretinoin is the drug of choice. It the only drug which offers any chance of long term cure and after a full course of isotretinoin significant number of people never have a recurrence of there acne. For you, in addition to Isotretinoin, I would suggest an oral antibiotics as well, to bring down the flare/inflammatory papules/pustules. For inflammatory acne(papules and pustules) I usually advice my patients to start with Azithromycin 500mg. The antibiotic can be continued for 4-12 weeks depending on the response. In addition to oral retinoids and oral antibiotics you must also use topical antiacne remedies e.g benzoyl peroxide gel OR Clindamycin+nicotinamide gel (as you have been using already). Since Acne and seborrheic dermatitis/dandruff are usually associated it is advisable to use an Anti-dandruff shampoo since acne is worsened by dandruff. regards