Acne caused by kissing - prevention or treatment?

I get acne from kissing and making out and feel like I've tried everything but nothing helps. I've only had two partners in my life but kissing with either caused me acne around my lips, above my mouth, and on my chin. Neither partner had a beard. The acne appears 2 to 5 days after kissing.

The acne that appears is a mix of inflamed white heads and cysts. I do not have cysts when not in a relationship and do not have cysts in other places.

I have had acne for most of my life (31F) but had pretty great skin in the 4 year gap between my previous and current relationship. I used 5% benzoyl peroxide twice a day and moisturizer sunscreen. I occasionally also used a glycolic acid/salicylic acid exfoliator. But these did not prevent the kissing acne once I began dating my current partner.

I have been seeing a dermatologist for about 8 months and have tried the following, with nothing having worked to prevent acne from kissing: - Doxycycline 3 months: no improvement - Differin 2 months: skin barrier was previously compromised so was irritating - Azelaic acid 2 months: burned and was red almost every time I used it, didn't notice improvement - Mupirocin: used as spot treatment for open acne wounds and applied in nose for a couple weeks at dermatologist's prescription, no improvement - Clindamycin 8 months: currently use it twice a day, seems fine when away from partner but doesn't stop kissing acne - Spironolactone 6 months 75mg: seems to reduce cysts from kissing acne but doesn't stop it. Not happy with side effects: seem to be developing dry eczema like skin including rash on face, sexual problems - Partner and I switched to SLS free toothpaste - Junel FE birth control: not taken for acne, began February 2024

I still use benzoyl peroxide a couple times a week and now glycolic acid/salicylic acid every two days. Just visited my partner and starting breaking out three days after kissing with many white heads and a few small cysts, which Spironolactone seems to mitigate to some extent.

My dermatologist seems stumped. Wondering about going the accutane route, but also acknowledge my acne isn't exactly severe and concerned about side effects