hi..thanks for your query . Acne can be a result of physiological changes in skin,well as be stimulated by an abnormal hormonal mileau in the human body.To ascertain the hormonal status,the common hormonal tests done are Serum Testosterone,DHEAS,S.prolactin,S.insulin,LH,FSH and cortisol.There should be an abdominal USG done to rule out pelvic pathologies.I assume the above have been done and are normal in your case. If topical applications cannot control the acne flares for you, I think you should start oral therapy along with.A number of other treatment are available and there is no need to worry even if you are not responding to the cream you apply.The various options are: 1)Antibiotics: Like Doxycyclin, azithromycin. for moderate to severe acne, you may need a short course of prescription oral antibiotics to reduce bacteria and fight inflammation. 2)Isotretinoin: For deep cysts, antibiotics may not be enough. Isotretinoin is a powerful medication available for scarring cystic acne or acne that doesn t respond to other treatments.It is very effective, but people who take it need close monitoring by a dermatologist because of the possibility of severe side effects. 3)Oral contraceptives.:Oral contraceptives, including a combination of norgestimate and ethinyl estradiol can improve acne in women. 4)Laser and light therapy: these reach the deeper layers of skin without harming the skin s surface. Laser treatment is thought to damage the oil (sebaceous) glands, causing them to produce less oil. 5)Chemical peels like Salicylic acid peels and Glycolic peels can be done intermittently by a trained dermatologist. Hope this is helpful...Take care!