I think you are right about multiple causes for acne. I had tried so many things for my skin and within a month of taking an adrenal cortex my skin just cleared up and it was pretty bad. When I took an adrenal glandular that wasn't the cortex, I did not get the same effect. Possibly that could point to cortisol being an issue for acne. I know we are all gathering information from each other and I made a vow with myself when I stumble on something that works for me that I will share the information and I hope it helps someone else. Here are some things I tried for my skin in the past:

Treated for demodex mites with cold cream
B complex (great to take but did not help skin too much)
Cleaned with oils
Cleaning the liver except Liver Flushing is too hard on me to do right now
All kinds of natural Acne creams
Zinc (Boudreaux's Butt paste)creams
Sulfur creams
Thyroid glandular (great for thyroid but did not clear skin)

If I think of more things I will post later...

The capsule form... American Biologics Adrenal Cortex. Let me know if it works. It took about 3 weeks before I noticed the Acne lessening. You can get it at Pureformulas for cheaper than other sites.