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I have seen this acne going and coming back like a cycle

[1] [2] Important tirzepatide warnings include potential reduced efficacy of oral contraceptives during initiation and dose increases

Common Triggers: Sunlight: UV rays stimulate melanocytes, exacerbating melasma

The classic symptoms of B12 deficiency are persistent fatigue, tingling or numbness in the hands and feet, problems with memory and concentration, mouth ulcers, a sore red tongue, and pale or yellow-tinged skin

5-Amino-1MQ and GLP-1 agonists (like semaglutide) work through fundamentally different mechanisms

So my advice, hang in there, take injections with folate etc too