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What could be the cause of this acne?

What could be the cause of this acne?
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Hi everyone!
I really don't know what to do anymore. My acne feels like it's only getting worse. The dermatologist couldn't help me. Has anyone had similar facial changes? What could be the cause of such acne? Acne is painful, sometimes I have a hard time opening my mouth. What could be the cause of this acne? I really am asking for help, because I have been fighting this for over 6 months


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