Dermatology Questions? Ask an Online Dermatologist.
It sounds like you may have nodulocystic acne or acne conglobata. These can cause inflammation and scarring even when the comodome burden is not that great. This degree of acne is typically not responsive to the usual conventional treatments such as antibiotics and topical agents, though these are usually tried first. I would suggest you see a dermatologist who prescribes Accutane and ask if you are a candidate for this medication. It is very effective for most acne, even recalcitrant cases.
You appear to have a mixed type of acne with some papules, developing pustules, cysts and nodules. I would recommend a prolonged course of antibiotics (e.g. minocycline or septra for several months) and a topical tretinoin cream. If you have tried this already, find a doctor that prescribes accutane, as it is the only medication I know that is almost universally effective when taken in the right way.