We're all after sound skin advice—and fortunately, we know exactly where to find it. When we heard from one of our readers requesting help with hormonal chin acne, we turned to a dermatologist for advice.
"Since coming off my Cerazette contraceptive pill about 18 months ago, my skin has really deteriorated, with the large majority of blemishes residing along my jawline and specifically toward the corners of my face," says reader Anna, who is based in London. "The skin on my jawline (mostly in the corners near my ears) has mild acne that's still much more than I'm used to. There are inflamed areas and lumps under the skin, and the texture is very bumpy. It's pretty constant, but I definitely see a slight peak during my menstrual cycle. I went to a dermatologist who advised me on some acid products to use (like Glossier's Solution, $24) and told me hormones were the cause. I've been using some of these products and seen improvements across my skin but less so in the real problem areas. I'd love to know which products, services, or treatments you'd recommend."
Meet the Expert
Alexis Granite, MD, is a U.K.-based consultant dermatologist specializing in general and cosmetic dermatology. She is an expert in skin cancer detection, skin allergy testing, psoriasis, eczema, and hormone-related skin conditions.
We asked Alexis Granite, MD, to answer our reader’s skin query with helpful, easy-to-understand, fundamentally reliable advice. Here, Granite offers advice for those who are battling the under-the-skin spots that so often appear along the jawline after coming off contraceptives. Read on for her explanation of why hormonal chin breakouts appear and what to do about them.
Types of Chin Acne
• Cysts: A severe type of breakout in which the pores are blocked, leading to infection and inflammation of the skin.
• Pustules: Small, tender bumps on the skin filled with white pus. These are most often seen in the areas of the body with the highest concentration of oil glands (such as the face, neck, chest, and back).
• Papules: Solid bumps on the skin containing no visible fluid. They often appear in clusters, much like a rash.
Granite says that Anna's case is likely a case of adult-onset acne and a combination of multiple types of breakouts. "You're describing both clogged pores called comedones and more inflamed papules and cysts, which are very common in adult-onset acne in women. These skin lesions are typically also seen in the areas you have mentioned—the lower face and neck."
Causes and Prevention of Chin Acne
• Birth control: While Granite says it's difficult to say if Anna's skin flare-up is entirely due to halting her use of Cerazette, a progestin-only pill, it is possible. "These types of oral contraceptives are not ones that typically improve breakouts and may actually exacerbate them in many women."
• Genetics: Still, the breakout could also be due to biology. "Genetics play a large role in the development of acne at any age, and natural hormonal fluctuations may trigger its onset as well," says Granite. "When we call acne 'hormonal,' it most often does not mean there's an underlying hormonal imbalance but rather is linked to a complex interplay of the hormones we naturally produce and our skin."
• Lifestyle: A number of lifestyle habits can affect the health of your skin, so Granite recommends keeping a healthy routine to avoid breakouts. "Stress plays a big role in acne, so anything you can do toward stress reduction will help—regular exercise, yoga, or meditation," she says.
• Diet: In addition to exercise, diet can also play a role, though it's unclear exactly how much of one. "There is limited evidence that our diet significantly impacts the development of acne," says Granite. "Several studies have shown a link between high-glycemic foods (such as refined sugars, potatoes, white rice) and skimmed dairy (especially in young women) with breakouts." She recommends trying to reduce potentially problematic foods and assessing for any improvement in your skin.
• Gut health: "It is possible probiotic supplementation may also play a role in reducing acne, but more studies are needed on this. Probiotics have many other health benefits, so they might be worth a try as well."
While dermatologists are trained at extractions, undertaking them at home could make matters much worse, forcing oil and bacteria from the fingers deeper into the skin. As with any breakout, the best treatment for hormonal chin acne is to leave breakouts alone. "Firstly, try not to pick much if you can help it—this can increase the risk of scarring," urges Granite. "If a cyst has developed a white head and seems ready to pop, you can try applying a warm compress to soften the skin, followed by gentle pressure. But if nothing drains easily, best just to leave the area alone."
Not only does picking irritate the skin via dirt and debris, but it may also rupture the skin follicle, leading to red marks and scars, and then creating an entirely new problem, on top of the breakout.
Retinol is a skincare powerhouse for a reason—it increases cell turnover, unblocking pores and clearing even under-the-surface breakouts. Thanks to all that pore-clogging power, it also helps other products to work more effectively. "For adult women, retinol is a nice option, as it has both anti-acne and anti-aging benefits," says Granite.
While high-strength retinol products require a prescription, there are a handful of over-the-counter products that contain the ingredient. The three prescription-only forms—tretinoin, adapalene, and tazarotene—are the gold standard. Because they are so powerful, it's best to ease into retinol use. Experts advise utilizing just a pea-sized amount, and starting slowly—using it once every few days until your skin adjusts. It's also important to use a moisturizer every day in conjunction with retinol products, as they may be very drying. Also, note that retinol isn't an overnight miracle-worker. It clears skin and leads to cell turnover gradually, so results might take a while.
Reach for breakout-busting ingredients.
As for the best over-the-counter products, try looking for those with breakout-targeting ingredients. "It may be worth adding in a dedicated acne product that contains an antibacterial and/or decongesting ingredient, such as benzoyl peroxide, salicylic acid, azaleic acid, and retinol," she says. "Often, however, for the deeper acne cysts as you're describing, prescription-strength medications can be more beneficial." A dermatologist may be able to prescribe topical treatments that contain benzoyl peroxide or salicylic acid but at higher concentrations.
See below for the ready-to-buy products Granite recommends.
This tried-and-true cleanser is non-comedogenic, so it won't clog pores, and gentle enough for dry or sensitive skin. It's also effective at removing makeup as well as daily oil and residue, making it an ideal choice for acne-prone skin.
This potion has a cult-like following, thanks to its ability to dry spots overnight. Formulated with calamine and salicylic acid, it works to shrink whiteheads overnight and is effective even on sensitive skin.
Salicylic acid and vitamin B3 promise to diminish the appearance of blemishes and brighten skin tone.
This triple-action product promises to dissolve oil, prevent future clogs, and soothe the skin with green tea extract. In other words, it dries up breakouts without drying out your skin.
This acne care system includes a cleanser, toner, and spot treatment cream. All contain a mix of salicylic acid and benzoyl peroxide, packing a one-two punch for breakouts and helping to keep skin clear with continued use.
Take an oral antibiotic or medication.
While topicals can be great, they are limited in how much work they can do when it comes to breakouts. Antibiotics are ingested, circulating through the body and targeting the root cause of breakouts: the sebaceous glands. "Trying a different combined oral contraceptive pill may also help, as can oral antibiotics or a medication called spironolactone, which has been used off-label for years to help treat hormonal acne in adult women," says Granite.
Other commonly prescribed antibiotics for acne include doxycycline and erythromycin, which are meant to help lessen inflammation and therefore breakouts. It's worth noting that antibiotics can lead to resistance, so they shouldn't be used forever, and some people might develop side effects as a result of adding them to their routine. They can also be used in conjunction with topical products, such as retinol or benzoyl peroxide, or alongside procedures like light and laser therapy as well as chemical peels.
Get a chemical peel.
If the above treatments don't help, a trip to the medical spa may be in order. "Medical-grade facials and extraction as well as chemical peels can help with the bumpy texture of your skin you have described; however, I generally only recommend these in conjunction with maintenance topical and/or oral acne treatments, as facials and peels will only benefit skin temporarily," says Granite. "Blue LED lights are also useful for reducing the bacteria on our skin that contributes to the development of acne, but again, results are temporary."
Common peels for acne feature glycolic, salicylic, retinoic, lactic, or mandelic acid—so think of them as higher-dose topical treatments. Be warned, however, that they're called peels for a reason. Your skin is likely to be red and possibly swollen for at least a few days following a chemical peel and could eventually peel and scab over (in other words, expect it to get worse before it gets better).
Wash your pillowcases (and other household items) more often.
As much of a no-brainer as it may seem, most of us don't wash our pillowcases (or towels, for that matter) as often as we should. If you have acne-prone skin, anything that touches it can make the problem worse. That means hats, towels, headbands, phones, makeup brushes, and sheets should all be kept clean and free of harmful bacteria. We touch our phones all day long, so not cleaning it (and then placing it on your chin or cheek) could transfer lots of germs and bacteria to your skin.
Experts recommend changing your sheets every week and your pillowcases two or three times per week and using a detergent that's geared toward sensitive skin, if you can. Wipe your phone down as often as you can or, better yet, use headphones when chatting, to avoid skin contact altogether. Wipe makeup brushes down once per day, if possible, with a more thorough soak once a week.
Wash your face twice per day—but don't overdo it.
Washing your face morning and night is a typical part of a daily routine, but it's especially crucial if you're prone to breakouts. If you exercise or sweat regularly, it's even more important. While sweating isn't necessarily harmful (in fact, it might help detoxify the skin), letting sweat sit on the skin can be. Sweat might mix with bacteria and dirt on your skin and, therefore, clog pores and lead to acne.
Be sure to wash your face with a gentle cleanser following a workout or sweat session, and clean exercise products (yoga mats, towels) regularly. That being said, over-washing can be problematic, as too much exfoliation may lead to inflammation. Harsh scrubs might irritate and tear the skin, much like picking and should, therefore, be avoided.
Zasada M, Budzisz E. Retinoids: active molecules influencing skin structure formation in cosmetic and dermatological treatments. Postepy Dermatol Alergol. 2019;36(4):392-397. doi:10.5114/ada.2019.87443
Xu H, Li H. Acne, the skin microbiome, and antibiotic treatment. Am J Clin Dermatol. 2019;20(3):335-344. doi:10.1007/s40257-018-00417-3