The #1 Culprit of Acne is your immune system. Its actually the reason u get red sore pimples. This actually has nothing to do with how strong or weak your immune system is but it has to do with the inflammatory response ur immune system causes and without this response you could never get Acne. Everyone has genetically different programs how their immune system reacts but there are many enviromental factors that contribute to inflammation. But you can control this through many ways including eating a strict anti-inflammatory diet has been proven to reduce inflammation in the skin. More detail later.

#2 Culprit is your bodies failure to communicate with hormones and nerves. Often we think its an hormone imbalance and while that stands true in many ways in the end the #2 culprit is when your body fails to communicate and overstimulates the production of sebum. People say Testosterone or DHT and Estrogen can overstimulate the production of sebum and while that is somewhat true its not always true. Simply put its more the failure to communicate.... your body can and has the power to control its production of sebum but most often intake of high sugary foods that spike Insulin and IGF-1 will overstimulate sebum production and naturally like for 1000 years ago this would never happen to the body so it has not adapted and this is one of the reasons you get diabetes. Your body is not adapted to highly sugary foods like icecream, donuts, coca cola etc... they cause a havoc on insulin. So avoid all sugar.

#3 Culprit is oxidation of sebum. This happens when you are basically eating food that has no nutritional value. You need Antioxidants to protect the sebum from oxidation which causes byproducts and it is this which causes overgrowth of bacteria. Sebum itself does not cause overgrowth of bacteria but when it is oxidized it creates byproducts which bacteria feast on and also oxidation is one of the causes of blackheads. Antioxidants from natural sources are a way to combat this.

#4 Bacteria overgrowth caused by overproduction and OXIDATION of sebum.... Bacteria on your skin is actually essential and DOES NOT CAUSE Acne by itself and never will this is why antibiotics only work for a few months... yes they reduce the bacteria reducing the immune inflammatory response but in the end if #2 and #3 is unaffected your Acne is guaranteed to come back because you can never kill off or stop P.Acnes from reproducing.

#5 Toxins, inflammatory foods etc - Again sugar is inflammatory... processed wheat etc causes inflammation throughout your body including your skin. Toxins wreak havoc on your immune system causing autoimmune disorders and more inflammation. This makes your bodies response to P.Acne overgrowth even worse.

#6 Stress - Here scientifically is how stress causes Acne - Stimulates cortisol and Cortisol increases blood sugar + eating high sugary foods = Very high blood sugar = insane insulin and IGF-1 spikes causing chaos in your bodies communication with hormones. Afterall hormones are a way of your bodies communication.

#7 Deficiency in essential nutrients - This is actually last because deficiencies often dont cause Acne but rather makes your body more prone and unable to heal Acne wounds as effectivly. Vitamin D3, B5, A, E, Zinc, Magnesium etc all help reduce factors that contribute to Acne.

#8 - Lack of sleep again leads to #6and #2...

#9 - Overstimulation. This includes being sexually overstimulated and also too much caffeine and even sugar...

Now listen up to this.... if you remove any of the #1-4 processes then you cannot get Acne.... so #1-4 is the MAIN culprits that cause Acne and just by removing one of them you will not get Acne. This is why Accutane works so well it destimulates the production of Sebum stopping Sebum also means it cannot oxidize nearly as much which also means bacteria cannot overgrow which means your immune system wont respond by inflammation.