Major causes of acne include intestinal health and lack of B vitamins. More below.

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Two root causes of acne are suprising. Intestinal health and low B vitamins.  Intestinal health is a major contributing factor to skin health. Improving the diet can result in suprising results in skin improvement. Avoid junk food, processed food and fast food and start adding healthy fats (Weston A. Price) to your diet. For more on skin health and B vitamins see  https://www.progressivehealth.com/acne-vitamins.htm

Another contributing factor is endocrine disruptors. "...Hormone disruptors are chemical contaminants in the environment that mimic our own natural hormones, and in doing so, scramble the messages our cells are giving to each other. They can have an impact, from minor to major, on any of the above hormones, but most frequently, mimic estrogen...." ~ https://avivaromm.com/

"GI symptoms (including bloating and constipation) are 37% more likely for those with acne – and may play a role in acne in many more women than that. Your gut health is central to hormone balance." ~ https://avivaromm.com/

More Resources:

https://www.progressivehealth.com/acne-vitamins.htm

https://www.insider.com/guides/beauty/home-remedies-for-acne

https://justaboutskin.com/2014/10/fighting-acne-inside-out/