So Frustrated and Derm Unhelpful

I've been dealing with acne for most of my life, but during covid my symptoms started presenting more in line with rosacea. I have tried everything my Derm has prescribed (after I did the research, she has never offered any advice on treatment other than approving medications I ask for) and I'm at my wit's end. Metro, AA, sulfur, Doxy, Altreno (a more gentle tret), you name it, I've tried it. I brought up Ivermectin a while ago, but she didn't think it would help. I asked about low-dose Accutane (I used it in my early 20s with decent results) but she won't prescribe it for rosacea. My last email to my Derm received a response of, "Sometimes rosacea just doesn't respond to medical treatments, I'm sorry."

So, now what? I am still using Altreno, but it has been 6 months and I haven't seen results, so I'm planning on giving it up. Other than that, I've only been using Aveeno oat gel moisturizer, Gleanser from Prequel, and hypochlorous acid spray. I have gone the no-actives approach before, and it was a disaster - acne comes back full force. So, that isn't a road I'm willing to go down again. My cheeks are constantly red, and my nose is constantly oily and broken out. There doesn't seem to be a combo of treatments that works for any of it.

I'm not really sure what I'm expecting from this post. I have stopped bringing up my insecurities with my partner (who has perfect skin) so I guess I just needed to vent. The attached pics are from a "good" week, fwiw.

Wishing everyone else luck with their own journeys.