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You also cannot verify absorption the same way you would with an injection

N-Acetyl-cysteine treatment improves insulin sensitivity in women with polycystic ovary syndrome

But again, I ask: what causes it

You have probably tried the usual fixes

While direct clinical trials specifically on active acne vulgaris are limited, the observed benefits are highly relevant to acne-prone skin: Improved Skin Density and Thickness: Clinical studies have shown GHK-Cus ability to increase skin density and thickness, which can contribute to a plumper appearance and potentially reduce the visibility of shallow scars

KPV suppresses inflammatory pathways at the cellular level, particularly in the gut