Concern · Acne · Hormonal pattern

P. 17 · GUIDE

Hormonal acne.

Jawline, premenstrual, persistent. Topical + sometimes systemic.

Adult acne, jawline-clustered, premenstrually predictable, persistent past the years anyone told you it would be. Treated topically the same way as teen acne — but the third lever is systemic. The patients who do not improve on a topical-only protocol almost always benefit from a derm consult about spironolactone or COCPs.

— § 01

The triggers worth tracking.

Jawline / chin pattern

Distinguishes from comedonal teen acne, which favours the T-zone.

85%

Premenstrual flares

Days 18–28 of the cycle. Predictable, hormonal.

78%

Persists past 25

Adult-onset or persistent — the defining feature.

70%

Co-existing PCOS signs

Hirsutism, irregular cycles. Worth a workup if present.

32%

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— § 02

Ingredients that actually work.

Tier

Molecule

Role

Evidence

Comedolytic retinoid

Reference OTC retinoid · 12-week RCTs

Tretinoin 0.025–0.05% (Rx)

Stronger; pregnancy-contraindicated

Benzoyl peroxide 2.5%

Reference for inflammatory papules · over decades

Azelaic acid 15–20% (Rx)

Anti-inflammatory · pigment

Excellent in pregnancy & PIH-prone skin

Tier A

Spironolactone (Rx, oral)

Anti-androgen

Strong in adult women · derm-prescribed

Salicylic acid 2%

Mild adjunct · not a primary treatment

⁂

— § 03

The protocol.

Morning

Low-pH gel cleanser
Niacinamide 5% — calming
Lightweight moisturiser (CeraVe AM, Toleriane Double Repair)
Mineral or hybrid SPF 50+ — non-comedogenic

Evening

Cleansing oil → gel cleanser (double-cleanse if wearing SPF + makeup)
Adapalene 0.1% (or tretinoin) — pea-sized, full face
Buffer: ceramide moisturiser
Spot-treatment: BPO 2.5% on inflammatory lesions only