I tried all active ingredients that fight acne applied topically but none is useful what is the next step ?

Dermatologist: Once you have failed to see results after exhausting over the counter options, evaluation by a dermatologist would be a reasonable next step.

Seeing the Derm Dr.: Acne can be very tough and difficult to treat as you are finding out. Sometimes it takes a concerted effort between the skin doctor and the patient to find the best treatment plan, which may include Prescription low dose antibiotics and or higher dose Prescription creams or medications by mouth, and sometimes even injections, etc. Good luck!