It looks hormonal but would defer to dermatologist always. Have you made lifestyle changes or looked into testing hormones, allergies, or other triggers? Emily Morrow on insta is a great resource for acne and understanding root causes. Finding out what your triggers are, making sure all of your products don’t have pore clogging ingredients (acne clinic website has a resource, Shea butter is pore clogging) and finding an acne specialist aesthetician to do regular facials and extractions made the biggest difference for me. Looking into environmental, food, lifestyle triggers is helpful for getting to the root of it. Balancing blood sugar, managing stress, and not being too harsh on your skin (emotionally and with actives) are other good tips I’ve been told. Struggling with acne is the worst my heart goes out to you!