I know how you feel. My friends always say "why do you care so much about having acne" (none of them of course HAVE acne)...I've had it since I was in high school (so for roughly 15 years) and whenever flare ups have been bad I get to the point where I just want to hide away. I've never actually called in sick to work but believe me my finger has been on the button several times. It doesn't make you vain or shallow or anything like that so don't give in to the negative thoughts.
I'm sorry to say I don't know much about liver cleansing. I can tell you that the reason antibiotics and spironolactone probably aren't working for you is b/c neither of them alters your hormonal balance...and frankly, aside from Dian 35 (which has an antiandrogen like spironolactone) I've never been on a birth control pill that's done much for my skin condition. Antibiotics just control infection and inflammation and antiandrogens simply prevent the hormone from attatching at the receptor site (sebacious glands)...which is probably why you haven't had success with them alone. However, I think because Dian 35 is a combined birth control pill/anti-androgen - might explain why it works so well for women with acne (that is, if you don't have the adverse weight gain effect like I did). It took about 4-5 cycles before my skin cleared up completely literally within a week. I was amazed but I had to swap acne for weight gain so I stopped taking the Dian-35 and now am on Alesse and want to try Aldactone as it's very obvious that I do need an antiandrogen. Another birth control you might want to try (which we can't get in Canada) is called Yasmin which also has an anti-androgen but also has a diuretic-type effect which prevents weight gain. Good luck to you.