A 14-year-old girl comes to you for concerns about acne. She is well-nourished, with good hygiene. She is active in sports- playing volleyball almost year-round. She also complains of dysmenorrhea, but denies sexual activity. Her exam is normal except for multiple infected cystic lesions on her face, back and chest. Scattered blackheads are observed over the nose and cheeks as well. 1. What are the contributing factors for the etiology of this teen's dermatologic problem?