At 35 i still have severe acne have used accutan,spironolactone,differin (adapalene).... what else can i do?

Endocrine issue?: Have you been evaluated for an endocrine problem? Sometimes abnormal levels of certain hormones can cause severe acne. If not, I would recommend that you discuss it with your physician. I'm assuming you have already seen a dermatologist.

Not much: Just learn to live with acne and try a combination of OTC and prescription acne meds to keep the symptoms under the best control. Modify diet, keep well hydrated, avoid stress and sun exposure for good measure.

Keep managing it: I was able to stop using meds for my acne when I was around 50. There's no figuring why one person's acne hangs on after other folks' has self-cured. It's nothing involving your lifestyle, hygiene, or diet. A hormonal problem may be identified, and you may be offered a trial of the oral contraceptive pill, which has other health benefits as well. Best wishes.