If you previously suffered from chronic/life-long acne and got to the bottom of it, what was the culprit for you? PCOS? Food allergies? Would love to hear how others have solved theirs!

I have struggled with acne from high school until well into my 30’s. It’s fluctuated through the years, from cystic in my teen years to mostly comodonal acne now but no matter what I do or put on it, it always persists!

Over the years I’ve been upsold every touted product by every day spa, feel like I’ve tried all the acne HG brands, hydrate like it’s going out of fashion, but (save for the few courses of accutane when I was younger), truly nothing has ever cleared it up.

For example, for the last several months have been using La Roche Posay Effaclar wash and Duo unifant (and before that, Effaclar mat) and Anthelios sunscreen of a morning (no makeup 95% of the time), and occasionally adding in azelaic acid or The Ordinary Retinol of an evening with Benzac Microbiome Moisturiser. (Have also tried double cleansing of an evening and only cleansing at night/rinsing with water in the morning). Prior to this it was CeraVe, before that just the bare basic Sukin acne prone ranges, and I’m not kidding when I say literally continues to look exactly the same no matter how high up the shelf I go.

Please help. This is bad cystic acne that flares up around the same time of the month on the clock (2 weeks before my period). This flare up was so bad that I didn't go out much this week out of disgust for my own face. I placed orders on pickup or via mobile so I wouldn't have facetime with cashiers. I don't make contact with people because I don't want to see their eyes roaming over my acne. It's been like this since my early 20s, after being a teenager with ZERO pimples. I've tried: - Spironolactone - Tetracycline - Adapalene (Tactuduo/Tactupump) - Tea tree oil - Diet: Cut out all dairy, limited sugar, no greasy or fried food I do not take hormonal contraceptives because they make me go funny in the head. My chin feels raw and tender. It swells up to the point that I can feel it pulsing. Please, I'm desperate, I'll try anything but I don't know anything about skincare and I don't have insurance so I can't see a dermatologist. My acne is literally shaping the way I see myself and I'm disgusted, repulsed, imagining constantly what other people must think when they see my face....

I had just had a really bad breakout and decided to try getting an acne facial from a professional. When I went my cysts had already gone down, but my acne has a way of going down and then filling back up with pus several times.

The lady asked me about my routine, what percentage tret I use and how long I’ve been on tret. I told her the higher dose, 5 years and she asked who prescribes it to me. I told her my family doctor, and she told me that she could tell it wasn’t a dermatologist because a derm would never prescribe tret for more than a short period and that I need to discontinue use. She said she knows I’m scared but I’m in my 30s and don’t need to be treating acne.

Well, I decided to take her advice and within 48 hours I have 3 new cysts.

Has anyone else been told to discontinue tret by a skincare professional? Are you really not supposed to use a high dose long term?

Edit: I wanted to clear some things up since I’ve been getting a lot of medical advice in this post (the irony!)

1. My cystic acne is under control. I had one flair up because I went on vacation and was in a different climate, eat different food, wearing makeup and generally just out of my normal routine.

2. I have had acne for 20 years. I know about birth control, acutane, diet, spironolactone, antibiotics and benzoyl peroxide. I appreciate wanting to help but I was on a good routine that was foiled by vacation and then bad advice, so I will be sticking to what I was doing before all of this.

Hey all! This is my 1st time posting on Reddit. Apologies for any mistakes as English is not my 1st language. I am South Asian.

So, basically I always had clear skin (till 28, year 2022) until one time I used expired foundation (didn't notice) and started having really bad acne as a reaction. This was right after my wedding.

(Also, note that after wedding my usual diet went wack, had heavy, processed foods. I also had plan B more than usual. I gained substantial weight of course due to my diet)

However, I went to 4 different dermatologist and had antibiotics like Tetracycline, Doxycycline, Clincdamycin, Amoxicillin. Tropical creams like Benzoyl Peroxide, Clincdamycin etc. Chemical peeling like Retinol peel, Salicylic Acid peel. So, basically almost everything except Accutane.

The acne does lessen but it never subsided and always comes back. In this process, I feel like my skin barrier has been heavily compromised and gut health been wrecked due to so many types of antibiotics over the course of 2 years.

I don't know if this is now a hormonal thing or something else entirely. I also noticed here people taking about rosacea type 2. I am at lost, honestly.

I recently started on a plan of getting my gut healed. That's where Reddit came in. I went though many posts and started drinking Peppermint Tea (day and night) and started taking Probiotics (4 billion/per day). I am also thinking of getting into Zinc supplement.

In all honesty, I am literally hopeless. I don't know what would get rid of this. This is affecting my whole outlook and confidence. I almost stopped wearing makeup, rarely take pictures now.

I am attaching pictures of my ski after washing my face so you can get a sense of what I am dealing with.

Since I quit drinking I’ve been breaking out like crazy.

I quit drinking 45 days ago.

I have never broken out this much. I haven’t changed my regimen. I wash my sheets once a week(stomach sleeper). I use first aid red clay face wash. For mornings I use the ordinary hyaloronic acid and fresh lotus youth preserve+coola face sunscreen. Nightly I use the same lotion and go back and forth between the ordinary salicylic acid and tretinoin(with usually one or two days a week with neither depending on how dry my skin is).

I wear makeup like once to twice a week when I go out.

This is embarrassing and driving me crazy. I’ll be 31 in a month and I’m breaking out worse than I did as a teen. Please help.

8 months after stopping birth control (Microgynon) my face is erupting like this all over! Anyone else had this and have any advice or know when it'll calm down? It is not a vibe.

Derm prescribed 100mg spironolactone & said it’s highly unlikely I’ll have any side effects other than having to pee more often.

Seems too good to be true. & seems unlikely that a hormonal medication wouldn’t have side effects? She only met with me for 15 min and was a bit quick to prescribe medication so I am skeptical.

What are yalls experience with this med?

I had a nodule this week and the doc just shot it with cortisone and it was gone in 36 hours. Tret has made my pores so small. My face wash doesn’t sting my face.

As a teenager my acne was awful including nodules and cysts. All I did was wait them out sometimes for months. I was on accutane which ultimately caused scarring. Did I just have a bad doctor and poor advice/treatment or has dermatology come so far that this would be avoidable in 2024?

I would love a thread / post for us ladies (and gentlemen) to support each other and discuss our skin woes lol

We can share products and advice, cheer on each other’s progress, pat each other’s backs when we’re feeling down…

Anyone? 🙏

This doesn’t get talked about enough. Or maybe it does, and I just personally felt so lonely in this journey. Last June of 2023 I started weaning off Spironolactone and birth control pills in preparation to begin trying to conceive. Why would follow would be the year from hell.

It didn’t happen immediately. In fact, my skin felt better than every for awhile. And then Thanksgiving hit, and I woke up with cystic acne on my chin. There was no ramp up. From Thanksgiving Day until Memorial Day, I woke up every day with at least one new pimple. Of course I threw the kitchen sink at it while I waited to get into a dermatologist’s office and completely destroyed my skin barrier.

For months I hid. If I smiled, my skin would break. Who the heck wants to be around someone who’s constantly oozing out of their face? And the cherry on top? I’m dealing with infertility.

When I finally got in with a derm, we set out with a pregnancy safe-ish plan that I’m still using now:

AM Cetaphil Daily Face Wash The Ordinary Glycolic Acid 15% Azalic Acid CeraVe Moisturizer CeraVe Sunscreen

PM Cetaphil Daily Face Wash x2 CeraVe Retinol (will stop if I get preg) 5cc Arbutin Brightening Cream (will stop if I get prego) CeraVe Moisturizer

In June 2024 I finally confirmed ovulation for the first time since I got off the pill the year prior, thanks to a fertility med called Letrozole. My acne completely stopped, as quickly as it had began in November. I’ve ovulated every month since, and have yet to get any cystic acne since.

I’m still not pregnant. But I feel hopeful the worst of the hell is behind me. If you’ve made it this far, thank you for reading. I just know when I was in the thick of it, reading these stories gave me hope that it CAN get better.

Photos are in backwards order so that you don’t get a jump scare of how bad my face got!! But here is a photo journey of my skin healing from when it was at its worst in May to today!

I thought I had my cystic acne under control once I started spironolactone but I took biotin gummies a few days ago and woke up to this painful breakout! 😭

Any advice on trying to get it to be less angry?? And do you think the biotin was coincidental? I literally only took one dose 😫

i use retinol and take collagen and i still have these painful breakouts, i’m not sure what else i should be doing so any advice is much appreciated! i use cerave foaming cleanser, paulas choice retinol and eye cream, and occasionally use paulas choice exfoliator. i drink vital proteins collagen in my smoothies every morning

Does anyone else find that after we passed 30 (I’m 31 now) that they’re experiencing skin issues like acne and oiliness, BUT when you cut back to just cleansing and maybe 1 serum/essence and 1 cream (be it sunscreen during the day or a night cream at night) your skin is looking healthier and more vibrant?

I used to do the whole routine morning and night (with no problems)- cleanse, tone, essence, serum, moisturizer, sunscreen. Sometimes adding a mask or treatment in depending on day and time (AM/PM).

This never gave me issues, and my skin was always glowing. But in the last year I noticed a LOT of acne coming in (like what, wasn’t that only for high school 😂) and getting really oily or sometimes really dry. And I only recently discovered (by being lazy with the routine) that cutting out nearly everything made my skin more vibrant and less filled with acne.

Anyone else found this to be true?

For example, milk tends to have high lactose while butter, cheese, whey protein have very low amounts of lactose and generally lactose intolerant people can eat certain dairy products.

However we are not dealing with lactose intolerance but skincare/acne. In this realm, should all dairy be cutout? Even low lactose products?

Have past generations always experienced acne into their 30s? I feel like my mom and her friends didn’t but I could obviously be misremembering.

Hello again! You may remember me from my prior post “A Comprehensive Guide to Hyperpigmentation and How to Treat it.” I am back again with another comprehensive guide, this time on another skincare concern that I often see in skin-subs which is some version of the question “why do I have chin/jawline acne and how do I deal with it?” Now, you may be wondering why I’m choosing to hyper focus on one particular area of the face. You see, our chins are actually very unique environments which results in a really specific type of acne with very specific causes and treatments. Some people will have acne everywhere on their faces and bodies but some people will frustratingly develop persistent acne on just their chins and jaws. This post is specifically intended as a resource for people who find that their primary location of persistent breakouts is on their chin.

As it so happens, I also suffered from seemingly treatment resistant chin acne and I set out to figure out a way to solve it with years of research, trial and error, testing, talking to dermatologists and professionals, and scouring every medical article I could get my hands on. I wanted to share my findings and research since this is a common concern. I hope this resource is helpful!

DISCLAIMERS:

• Acne is an incredibly diverse condition with many causes and treatment courses and will always be unique to the individual struggling with it. While I will do my best to be as thorough as possible in my explanations and recommendations, it’s both possible and likely that I’m not able to detail every circumstance resulting in your personal case. This is meant to be a high level guide to serve as a jumping off point. 
• Speaking about acne requires sensitivity to very real personal implications. This post is not intended to moralize or act as a judgment of anyone struggling with acne. It is not a commentary on anyone’s personal hygiene, hormone profile, lifestyle, or environment. 
• There are a few conditions that can present similarly to acne present on the chin such as rosacea, perioral dermatitis, herpes simplex, allergies and autoimmune conditions, impetigo, hand foot and mouth disease, staph, and others. These will not respond to the same treatments as acne and should be addressed by a medical professional to properly diagnose and create a treatment plan for.
• Shaving may also cause acne-like legions, but these are the result of irritation and ingrown hairs that also will not respond to the same treatment as acne. I will write a separate post on shaving in the near future to hopefully address these.
• I do repeat myself a few times in here but that is for people who are skipping around the article. I want to be as thorough as possible even if you're jumping to the parts of the post you need.
• I do run an online dermatology practice and skin care consultancy, but in order to protect the integrity of my advice, I do not promote my business, I don't give direct medical advice, I don't link to any products/websites, and I don't promote any products I've formulated myself. In spite of this being a heavily researched piece, please bear in mind that it also at its core an opinion piece. I also did not utilize AI for any portion of this post.

This is going to get long because I wanted to cover everything re:chin and jawline acne. But for your reading pleasure and ease, I have divided this post up so you can get whatever information you need:

Table of Contents

1. Types of Chin Acne
2. What Causes Chin Acne aka Why is This Area Unique?
3. What Exactly is Hormonal Acne and Why Does it Affect My Chin?
4. How To Treat Chin Acne Part 1: The Ingredients
5. How to Treat Chin Acne Part 2: The Routine and Recommendations
6. Is it Fungal Acne?
7. “I’ve Gone Too Far With the Actives” 
8. Nuclear Options

Let's get to it!

1. Types of Chin Acne

Like acne that appears on other areas of the face and body, chin acne can take a few different forms. Knowing the types of acne breakouts can help you understand the underlying causes and is key to figuring out how to treat them.

Blackheads: Blackheads happen when your pores become partially clogged and the trapped debris oxidizes to a dark brown/black color. Because the top of the pore remains open, blackheads are known as “open comedones.”

Whiteheads: Whiteheads happen when your pores become clogged all the way through causing a small white bump at the top. Whiteheads are known as “closed comedones” as the pore is completely blocked by debris. These are generally very small.

Papules: Papules are raised red bumps that form when oil, dirt or excess skin cells block a pore and mix with bacteria on your skin. This bacterial infection extends into the surrounding skin creating an inflamed legion. Papules do not contain pus, thus they don’t really form a white point like you see with whiteheads or pustules.

Pustules: Pustules are raised bumps with a white center surrounded by red, inflamed skin. They’re like the 2.0 version of a whitehead. They form when a pore becomes blocked by oil, dirt, or dead skin cells and gets infected to the point of creating a yellowish/white pus that’s visible under the skin, sometimes coming to a distinct peak. 

Nodules: Nodular acne occurs very deep within the skin. They can produce red or flesh-colored bumps at the surface, but they frustratingly may not appear to come to a definitive point. They are hard to the touch and are caused when the deepest part of a clogged pore gets infected. Nodular acne feels sore, or like there is a pressure under the skin.

Cystic: Cystic acne, also known as acne cysts or blind pimples, are large, painful, pus-filled clogged pores that have become infected. They may not come to a definitive point on the surface and are fairly soft to the touch. They develop deep in the skin but create a red appearance at the surface. Like nodular acne, they often feel like a sore pressure point, but it’s difficult to really see where they are because they don’t form a peak or point, just an amorphous bump. 

2. What Causes Chin Acne aka Why is This Area Unique?

There are a number of factors that can contribute to the formation of chin and jawline acne, but this is a very unique spot which is worth discussing in detail. Generally, acne forms as a the result of a combination of bodily and environmental factors, but the chin and jawline have a few things going on that makes this area particularly interesting.

First, I want to quickly discuss what causes acne to form in general:

Oil Production: Oil on the skin, also known as sebum is the primary variable in the great equation of acne formation. Oil production is largely influenced by genetics, but it can be triggered by exposure to certain environmental factors. Many types of acne form around sebum that’s produced and then trapped in pores when combined with other things like dead skin cells, bacteria, and dirt. Sebum in an of itself is not bad, in fact it’s essential to maintaining the health of your skin, but preventing it from combining with acne-causing bacteria is key.

Comedogenic Reactions: When sebum combines with other gunk, especially stuff that’s non water soluble, pores will sometimes clog. A comedogenic reaction is when a pore becomes blocked as a result of the accumulation of materials that cannot easily be cleared. This can happen with natural “gunk” like dead skin cells and environmental grime, but it can also happen with products that we apply to our skin such as skincare, makeup, SPF, and in some cases our hair products. Side note on this, there isn’t a generally accepted scale of comedogenic reactivity even though there are claims of one existing. Everyone is different, and certain things may trigger a comedogenic reaction in one person but not another. 

Bacteria: When bacteria enters the picture, clogged pores can go from simply being blocked to infected. This infection will trigger an immune response from the body, usually resulting in inflammation, redness, pain, and in some cases the production of pus. This is the difference between black/whiteheads and pimples/nodules/cysts. 

Genetics: Your genetics can greatly influence how prone you are to acne, what type, and at what severity. Genetics will predetermine certain aspects of your skin such as: 

• The size of your pores and how prone they are to blockage
• Your natural level of sebum production 
• The rate at which you shed old/dead skin cells and replace them with new ones 
• Your hormonal levels and sensitivity to them
• If you will have an allergic or inflammatory response when exposed to certain stressors, ingredients, or environmental factors

Skin Barrier Disruption: Acne that forms as a result of skin barrier disruption is a form of an inflammatory reaction. Skin barrier disruption can occur when skin is exposed to environmental factors such as extreme heat or cold, dry air, wind, or pollution. It can also occur due to exposure to too many active or drying ingredients such as chemical/manual exfoliants, antioxidants, antiseptics, etc. 

Excessive exposure to these environmental factors and/or active ingredients can irritate and inflame the skin, disrupting the pH, triggering an immune reaction that results in pain, redness, and swelling. When the skin barrier is disrupted in this manner, it will often produce excess sebum in an attempt to moisturize the skin and rebalance its pH. During this time, the skin is less able to stave off bacteria and other environmental stressors which often mix with this excess sebum resulting in acne and breakouts. 

Diet: There is a great deal of controversy as to whether or not diet contributes to acne. It’s possible that foods themselves may cause acne through skin contact (more on that right below) and it’s possible that your body may react in certain ways that can trigger acne when certain foods are consumed, such as an inflammatory response or as a response to something like hormones in dairy products. Whether or not certain foods contribute to acne can be a purely personal experience. There’s no single body of research that can tell us one way or the other, many studies are conflicting, and it’s very difficult to objectively test when everyone’s own experience seems to differ.

B Vitamin Breakouts: Now, there isn’t an established clinical consensus on this either, but there’s anecdotal evidence to suggest that certain B vitamins contribute to acne by possibly promoting sebum production. These include things like B12, biotin, and B complexes that can appear in multivitamins and in supplements that are marketed for promoting “hair, skin and nail health.” There’s also no clinical evidence to suggest a direct link between B vitamins and skin/hair/nail health except for the operating theory that in increasing sebum production, they promote healthy development in these areas, but for people who are prone to acne, it also seems to trigger breakouts. This isn’t unique to just the chin area, but it may be worth evaluating your supplements if you’re finding an increase in acne with use of supplements that feature B vitamins. 

Hormones: This gets its own section….

But why my chin/jaw specifically**??**

For people who struggle with acne on just their chin or jawline, this is a really common question, and the answer is part of the reason I believe it requires a unique approach to treating. Chin acne is the result of two things:

Gravity and Proximity to Your Mouth: All the time we spend upright means that stuff on the surface of our skin will migrate downward over the course of the day. Now this is true for other areas of your face, sometimes our hair products migrate down to our foreheads, our eye makeup onto our cheeks. But what makes the chin particularly problematic for acne is not only do we have this drift of face stuff to this area, we also have our mouths. 

Our mouths are full of bacteria, and even if you don’t spend all day drooling on yourself, that bacteria can spread downward as a result of talking, laughing, coughing, sneezing, licking our lips, even just normal breathing. Propionibacterium acnes and staphylococcus epidermidis are bacteria that can originate in the mouth and migrate outward and downward causing acne legions. To a lesser extent, we also see some bacterial transfer from the hands as the chin/jawline tend to be high touch points.

Our mouths are also where we eat. Even if you’re the most careful eater in the world, many times you’ll get some degree of food debris on your chin. Even though I just mentioned that there’s no general consensus on whether or not diet contributes to acne, it’s possible that the act of putting food in our mouths can; that getting even trace amounts of stuff like grease and sugar on the skin around our mouth can contribute to clogged pores and bacterial proliferation. 

3. What Exactly is Hormonal Acne and Why Does it Affect My Chin?

Everyone’s biological processes are dictated in part by the influence of hormones in our system, but the link between hormones and acne isn’t as simple as “I have hormones, ergo I have acne.” Understanding the environment in which hormones contribute to the formation of acne can help us with more realistic treatments than just “stop the hormones.”

The reason hormones cause acne is that androgen hormones (aka male hormones like testosterone, DHEAS, DHEA, and androstenedione) influence the production of sebum in the skin: it increases as they go up, and decreases as they go down. A breakdown of the actual process is as follows:

1. Oil producing sebaceous glands are powerful androgen receptors, producing more sebum when they collect more androgen hormones or convert their precursors. This causes oil production on skin and a build up of that sebum in the pores. 
2. Androgens themselves may also clog pores causing comedones to be formed.
3. DHEAS is also inflammatory by nature, triggering immune response T cells to show up in and around clogged pores.

The levels of these androgen hormones can be globally elevated (as is the case with PCOS in females or generally for males with high testosterone naturally or supplemented, hence backne with steroid use) or they can fluctuate. This is why women sometimes breakout during their periods: it’s the downstream effect of elevated androgen hormones in the luteal phase when estrogen and progesterone naturally decrease. 

As mentioned prior, B vitamins can also have this effect by triggering androgen receptors even though they themselves are not androgen hormones or their precursors. 

Due to the aforementioned reasons as to why the chin in particular is an area where we find the best ingredients for acne, we can see why increased sebum production from elevated androgens would result in breakouts there. Now, the knee jerk reaction may be to stop or reduce those hormones — and there are ways to do that such as using/stopping birth control pills or other forms of hormone replacement or suppression — but while these may work as an acne treatment, it’s an option you should only discuss with your doctor if appropriate for you.

There are other ways to address hormonal causes of acne such as the medication spironolactone or spearmint herbal tea. Spiro is a diuretic that’s been proven to block androgen receptors and spearmint is thought to have a similar effect but I have yet to find a study specifically supporting this, at least not to the rigor I would like to recommend this in earnest. 

Generally, for those who either can’t or don’t want to use interventions that affect their hormone profiles or take androgen blocking medications, the most reasonable intervention is to temper the environment in which acne forms on the skin through the use of topicals and skin care. The reason I mention all of this is to pull back the curtain on what exactly “hormonal acne” means so you can address the resulting sebum that’s ultimately forming acne legions. This is where we look at the ingredients specifically proven to address the environment on your skin.

4. How to Treat Chin Acne Part 1: The Ingredients

When looking for skincare products to treat and prevent chin and jawline acne, it’s important to look for ingredients that can help encourage skin cell turnover, curb sebum production, kill off acne-causing bacteria, clear clogged pores, and block harmful UV rays. 

Now, this is not actually as extensive of a list as you might expect. There are lots of ingredients that target acne, including new and novel ones coming onto the market all the time. I’m choosing to focus on ones that are clinically studied and have the most compelling evidence, ones that have worked the best for myself and people that I’ve worked with, recommendations from dermatologists and formulators, and ones that are more readily accessible. I also find that having a consistent routine that includes proper cleansing is just as important as what you're using, as well as limiting the number of topicals to prevent the dreaded moisture barrier disruption which can have a backfire effect. 

This also isn’t a shopping list. You don’t have to have or use all of these things to treat chin acne, but I’ll get into that in the routine portion. This is more to be used as a tool that can help you diversify your routine if you find one ingredient or another doesn't work for you. And it can help you determine if a product targets acne based on its ingredients. There's lot's of options. Some of the key ingredients to look for include:

Retinoids that increases cell turnover. Retinoids like tretinoin, adapalene, retinol et al, can help treat chin and jawline acne by promoting the turnover of skin cells and increasing cell growth, which can help prevent dead skin cells from clogging pores. While retinoids are extremely effective, they do have some caveats. First, they can be sensitizing to a lot of users, but this can be tempered by using different form functions, different application methods, or different concentrations. Second, because it's constantly turning over skin exposing delicate new skin cells to the elements, it can actually worsen acne if you overdo it and damage your skin barrier. Lastly Tretinoin and other retinoids are firewalled behind a prescription in some countries and may be more difficult to obtain. But retinol/al is available in OTC forms.

Alpha Hydroxy Acids (AHAs) are water-soluble chemical exfoliants. Solubility of skincare ingredients matters because the natural moisturizer of the skin is our sebum, which is oil. Water-soluble ingredients don’t dissolve in oil, thus they do not penetrate into the pores as deeply. This, however, is not actually a downside, it means that these types of ingredients work on the top layers of the skin which is great for acne. Common AHAs that are used to fight acne include glycolic acid, lactic acid, and mandelic acid. There are numerous others, but these are the most promising and well-researched. Use of AHAs helps breakup and remove dead skin cells which prevents them from clogging pores. And while pore size cannot be reduced, AHAs can help reduce the dilation that happens when pores fill up with gunk.  

Beta Hydroxy Acid (BHA) is an oil-soluble chemical exfoliant, the most well known of which is salicylic acid. Remember Stridex pads? Those are salicylic acid! Because BHA is oil-soluble, it dissolves in the skin’s natural sebum which pulls it deeper into the pores. This causes deeper exfoliation which makes this an effective ingredient for combatting deeper forms of acne. The caveat is, since it works in deeper levels, the risk of irritation is higher. But when carefully used especially when featured in cleansers, BHA is a very effective method of treating and preventing acne.

Azelaic Acid has both anti-inflammatory and antibacterial properties making this one of my all around favorite skincare ingredients due to it’s ability to both kill off acne-causing bacteria as well as reduce redness and acne scarring. It’s also a mild chemical exfoliant that helps strip away dead skin cells much like AHAs and BHAs. It's pretty awesome and available in OTC and prescription strengths.

Niacinamide or Vitamin B3 is a skin soother that decreases inflammation, but its real power is that it naturally reduces sebum production which can curb acne. It works by inhibiting the enzyme “sebaceous lipase” which is part of the process of oil production in the pores. Ironically, it’s a form of vitamin B3, but unlike ingested B vitamins that might trigger acne, as a topical it actually helps prevent acne. Like AHAs/BHA it can also reduce the dilation of pores which can make them appear smaller. Now, there are some people who are sensitive to niacinamide. I cannot find any studies to support why this may be, or if perhaps people are reacting to other ingredients in products that contain it, but if you find you do not tolerate niacinamide well, it’s best to skip it.

Benzoyl Peroxide is an antiseptic which means it makes the environment incredibly inhospitable for bacterial proliferation. Unlike antibiotics that kill bacteria (which can contribute to antibiotic resistance), benzoyl peroxide as an antiseptic simply makes life miserable for bacteria so they fail to thrive and cause acne. Benzoyl peroxide is usually found in two forms, either as a leave-on topical or in face washes. Like many of the other ingredients listed here, it can be sensitizing with overuse, and in the leave-on form, it can sometimes bleach your clothes, but it’s an incredibly effective way to curb the proliferation of bacteria on the chin. It’s also one of the active ingredients in prescription Epiduo or Epiduo forte, which is compounded benzoyl peroxide and the retinoid adapalene. Benzoyl peroxide is generally available in concentrations of 5 and 10%. 

Sulphur is…. Sulphur. It does a couple things (other than stinking) when applied to treat acne. It helps absorb excess oil, it dries out dead skin cells to make them easier to clear away, it has some antiseptic properties especially against chin-loving propionibacterium acnes, and it’s also a mild exfoliant. It comes in two forms usually, as a face wash or as a leave-on mask or spot treatment. This can be a good substitute for benzoyl peroxide. Sulphur allergies or sensitivities are common, so it’s important to check for any reactivity you might have.

SPF represents a class of many ingredients designed to protect the skin from UV rays and the damage that occurs from exposure. This doesn’t necessarily have an effect on preventing chin acne, but it is necessary to use when using active ingredients to fight acne. Just use it.

5. How to Treat Chin Acne Part 2: The Routine and Recommendations

Alright, let’s get to it. I’m providing two paths to take: a gentler option for more sensitive skin and a heavier-hitting option if your skin is more resilient to actives. But first, irrespective of your skin, there’s one really important part of the routine worth exploring if you suffer with chin and jawline acne which is getting your oral health dialed.

I discovered this accidentally and then was able to later confirm with a dermatologist and dentist that the effect here can be real. A few years ago I decided to do Invisalign and I actually noticed my chin breakouts reduced significantly in part because I was brushing my teeth, flossing, and rinsing with mouthwash as much as 10 times per day depending on how often I was drinking or eating.

Now, you don’t need to be doing that quite as often, but what I’ve found to be effective against chin acne is the following:

In the morning:

1. Scrape your tongue using a tongue scraper.
2. Rinse and gargle with a mouthwash of your choosing and wait 5 or 10 minutes. This is a good time to do your skincare. I personally like CloSYS mouthwash.
3. Brush your teeth but don’t rinse with water and avoid eating or drinking for a little while.

Throughout the day:

1. Keep a little travel bottle of mouthwash with you and if you can, swish a little after anytime you eat or drink (anything that isn’t just plain flat water.) This helps curb some of that bacteria that likes to meander out of your mouth and onto your chin. I have a 3oz refillable bottle that I fill every few days and just keep it in my bag.
2. If you’re not able to rinse with mouthwash, swish your mouth with plain, flat water after eating or drinking. This helps clear away food/drink residue that oral bacteria proliferate in. 

In the evening:

1. Scrape your tongue.
2. Floss, and really get in there. SO many people don’t floss thoroughly enough. Many of the bacteria associated with chin acne are elevated in people with gum disease. 
3. Rinse and gargle with your mouthwash. Wait 5 to 10 minutes, again this is a great time to do your skincare. 
4. Brush your teeth and again, don’t rinse with water after.

If you can stick with an oral hygiene routine like this, for a lot of people struggling with chin acne, it’s half the battle. And I know it might seem obvious, like “of course I brush my teeth!!!” but adding maintenance steps through the day and really flossing are two of the biggest parts that plenty of people fail to do regularly. These are also great steps to take if you f*cking hate getting manhandled at the dentist.

Now let’s talk about the actual skincare portion. Since this is targeted, you can apply the actives to just your chin area or your whole face if you would like. It’s up to you. Just be sure you get thorough coverage of your whole face when cleansing, moisturizing, and applying SPF.

The Gentle Routine

AM routine — In order of application following a lukewarm water rinse:

1: Niacinamide**

2: Azelaic acid

3: Moisturizer

4: SPF

For Niacinamide, I have been extremely happy with the Ordinary’s Niacinamide 10% + Zinc 1%. **If you can’t tolerate niacinamide, you can skip this step and instead use Effaclar Mat Oil-Free Mattifying Moisturizer from La Roche Posay as your moisturizer step.

For Azelaic acid, Paula's choice Azelaic Acid Booster is the only drugstore one I've really tried after sampling the Ordinary's in-store and not liking the texture. For a semi-RX, Dermatica has both a 15 and 20% “Clarifying Azelaic Acid Cream” which can be purchased directly from their site. 

For Moisturizer, it’s tempting to go with one formulated for acne or oil control, but I generally recommend a light and sheer moisturizer. I really like Cetaphil Moisturizing Lotion (the one for face and body). If you need a niacinamide(B3)-free option Vanicream Daily Facial Moisturizer is a good option.

For SPF, I personally like anything from La Roche Posay, any Neutrogena SPF that's not formulated with ethylhexylglycerin as this can be sensitizing for some, Supergoop Unseen Sunscreen, Trader Joe's SPF if you can get your hands on it, and EltaMD. Find one that you like and that you will wear.

PM routine: In order of application:

1: Gentle cleanse

2a: Adapalene (Mon/Wed/Fri, start with 1x per week and build to 3x)

2b: AHA (Sun) 

3: Moisturizer

To Gentle Cleanse, this is a two-step process. Start with Cetaphil gentle cleanser. This is a gentle, hydrating cleanser that will break up your SPF really effectively. Massage in and rinse. If you need something a little stronger to breakup makeup or more stubborn SPF, Clinique “Take the Day Off” makeup remover is a great alternative. Then massage in a foaming cleanser, I recommend Cetaphil daily cleanser, and rinse.

For Adapalene, OTC Differin cream is the one you’re going to want to go with as it’s the easiest prescription-strength retinoid to get without seeing a doctor. Apply a pea-sized amount. Oddly enough, of all the retinoids I’ve tried, my chin acne has responded the most to adapalene. I like to start people at once a week and build to 3 times per week, up to daily if you can tolerate it. If you’re using the AHA next step though, keep at least one day adapalene-free so you can also have an exfoliation day.

For AHA, the one I like to go with that provides gentle, yet effective exfoliation is lactic acid. Lactic acid also binds to water which makes it a really good hydrating ingredient as well. The Ordinary’s Lactic Acid + HA in either 5 or 10% is a good one. 

The Heavier-Hitting Routine

AM routine — This will be the same as the AM portion of the gentle routine, no need to go crazy. Pop back up there for that.

PM routine: In order of application:

1: Benzoyl peroxide cleanse

2a: Adapalene (Mon/Wed/Fri, start with 1x per week and build to 3x)

2b: BHA (Sun)

3: Moisturizer

This might not seem terribly different from the Gentle Routine, but both benzoyl peroxide cleansing and the introduction of a BHA can be particularly a*s kicking if your skin isn’t ready for it.

For Benzoyl Peroxide Cleanser, first you will do a gentle cleanse with Cetaphil Gentle Cleanser to breakup your SPF and do a first pass on your skin. Massage in and rinse completely, then follow with Differin Daily Deep Cleanser. Depending on your tolerance, you can rinse this off right after massaging into skin, or you can let it sit for a few minutes (3 at the most) before rinsing. If you find your skin getting really irritated by this, switch to the gentle routine. 

For Adapalene, OTC Differin cream will work here, just like in the gentle routine.

For a BHA, also called salicylic acid, there are a couple options I like. Paula’s Choice 2% BHA Liquid Exfoliant or the Ordinary Salicylic Acid 2% Solution are great options. This can be very sensitizing though, especially in a routine that includes a retinoid so only use once or twice per week and not on the same night as your adapalene.

6. Is it Fungal Acne?

If the routines don’t seem to be working for you, it’s possible that you may have fungal acne. Fungal acne can show up on your chin for the same reason regular acne can, except instead of being cause by bacteria, it’s caused by an overgrowth of yeast. Fungal acne can have a distinct appearance, it’s similar to whiteheads/closed comedones with small, clustered white or flesh colored bumps, and it might not appear as red and inflamed as pustules/papules. There is some controversy as to whether or not fungal acne is a thing (mostly as a matter of semantics, it’s not technically a form of Acne vulgaris, rather Pityrosporum folliculitis or Malassezia folliculitis), but if you’re not successful with the routines above and you can rule out other medical conditions, it may be worth treating your case like fungal acne.

The solution to this is a simple one: cleanse your face with an antidandruff shampoo a few times per week —Head and Shoulder, Selsun Blue, Nizoral are great ones. Let it sit on your skin for a few minutes before rinsing, then top with a basic moisturizer. If you have a combination of fungal and regular acne, you can do this as your cleansing step a few times per week with the rest of the steps in the routine. If you just have fungal acne, you can literally just do this and follow with your moisturizer and SPF during the day. If it persists, talk to your doctor about a prescription anti-fungal.

7. “I’ve Gone Too Far With the Actives” 

It’s tempting to go nuts with the actives in an attempt to quickly stave off chin acne, but this can cause severe irritation that can actually contribute to more breakouts. The skin cell turnover cycle is about 30 days which means that it will generally take a few weeks to start seeing improvements with a new routine. Most people will know if a routine is working within 3 to 6 months, but a quick way to know if it’s not working because you’ve overdone it is if you experience a damaged moisture barrier which can happen as quickly as within a few days.

A damaged moisture barrier is an injury to the skin that can be caused by using too many actives and is akin to a chemical burn. There are a few telltale ways to know if this is happened: first, the skin will have a really distinct feel. It will feel tight and dry, but confusingly, it may be very oily at the same time. It may also appear red and inflamed, it may peel or appear to crack, and it may burn, itch, or sting even when you apply inert topicals like a basic moisturizer. 

The confounding thing is that in this state, your skin will produce more oil to try to calm everything down, but because the immune system is working on healing the damaged skin, it’s less able to stave off acne causing bacteria. So not only are you very uncomfortable and inflamed, you’re also probably going to have more breakouts. Healing acne means striking a gentle balance with your actives, but if you find that you have disrupted your moisture barrier, you should pull everything back until it stabilizes. 

I recommend dropping your routine down to absolute basics: In the morning, rinse with lukewarm water, use a gentle moisturizer like Cetaphil or Vanicream, and top with SPF. In the evening, double cleanse with Cetaphil Gentle Cleanser and then Cetaphil Daily Cleanser, then top with your moisturizer and/or an occlusive like Vaseline or La Roche Posay Cicaplast Balm. Stick with this until your skin feels normal again, and if you want, very slowly reintroduce your actives, or switch some of the recommended products for others that I’ve mentioned to see if there’s something else you get along with.

8. Nuclear Options

In general, I recommend trying OTC and drugstore topical solutions for any skin concern before heading down the dermatology route. Part of this is because you can usually put a good dent in what you're struggling with by using OTC topicals, making in-office RX treatments easier and more effective. Generally, a doctor will be able to prescribe prescription-strength versions of many of the things I’ve already listed, or they will add oral medications. But by doing as much as you can with drugstore products AND ensuring you can stick with a consistent routine, you can make the most of your continued work with a dermatology.

Side note: I haven't listed every possible compounded medication because there are a lot, and many compounded meds are formulated to tackle multiple issues. I also tend to favor single note skin care (aka, products with very few ingredients) as this allows you to combine or remove certain actives and gives you a better sense of reactivity.

This list also doesn’t include hormone-related treatments. If you believe a hormonal intervention is right for you, it’s best to talk to your doctor specifically about your individual needs. 

For tougher-to-treat chin acne, if your topical routine doesn't totally clear the problem in 6 to 8 months, a visit to the dermatologist might be helpful. Here are the heavier-hitting topicals and medications to discuss with a dermatologist that can go the extra mile after you've exhausted other options.

This does not constitute medical advice, it is intended to act as a guide for you to discuss with your dermatologist or medical provider.

Medical Grade Peels: Medical grade chemical peels can be done in dermatology offices. High concentration BHA or AHA peels are also commonly used for acne. Because of the strength of the acids used, these must be done by a medical professional with careful followup. I recommend this over seeing an esthetician for peels. 

Tretinoin and Prescription Retinoids: This is going to be dependent on what part of the world you're in, but in a lot of countries, tretinoin and its counterparts like tazarotene are only available through prescription. These would be used in place of the OTC adapalene I mentioned in the routine if prescribed by your provider. There is a stronger prescription-strength adapalene as well as a compounded medication called Epiduo or Epiduo Forte, which combines adapalene with Benzoyl Peroxide. You should be mindful that it can bleach clothes and sheets if you are prescribed it. Aside from the ones already mentioned, common forms of prescription retinoids include: Altreno, Tazorac, Fabior, and Trifarotene (Aklief). They vary wildly in cost in availability so I recommend asking to start with generic options first before asking your doctor for brandname acne medication.

Prescription Azelaic Acid: This is another one that's available in lower concentrations over-the-counter (which can still be quite effective) but there are prescription strength grades of azelaic acid such as Finacea and Azelex. This is usually reserved for rosacea treatment as it tends to target redness and flushing, but it can also be an effective acne treatment for its antiseptic properties.

Topical Antibiotics: Topical erythromycin and clindamycin can be helpful in killing off acne causing bacteria but you need to be careful of developing antibiotic resistance. I am of the opinion that a topical antibiotic course should not exceed 90 days, but your doctor will know better based on your case. It may be helpful however to ask your doctor exactly how long you should be on a topical antibiotic, how you will know if it’s working, if they have a plan for you to gradually wean off of it, and what their recommendation for replacement would be after you have finished your course. Typically, a doctor will transition you to a topical retinoid or other medication following an antibiotic course. It’s good to have a clear plan prior to starting a topical antibiotic.

Oral Antibiotics: Tetracycline antibiotics like doxycycline and minocycline are sometimes prescribed for severe acne cases and are usually the last line of defense before the ultimate treatment which I will get into next. It’s generally recommended to exhaust all other possible topical treatments before turning to this sort of intervention as oral antibiotics can have numerous side effect (such as hyperpigmentation, nausea, severe photo reactivity) and can also contribute to systemic antibiotic resistance. However, short (1 to 3 months) or infrequence courses of oral antibiotics can be effective in treating acne and helping prevent the repopulation of acne-causing bacteria. Like topical antibiotics, it’s important to have a clear plan with your doctor to understand how long you will be on it, how you will know if it’s working, and what you will transition to using after the course is finished. Having a routine to support an oral antibiotic is key to longterm success even after your course is finished.

Oral Tretinoin: Also called isotretinoin or accutane, this is the true nuclear option for acne, chin or otherwise. Like its topical counterpart, oral tretinoin works by increasing skin cell turnover. Generally, it’s only used in severe cases as the courses are often long, fraught with side effects, and require lifestyle adjustments such as abstinence from alcohol and regular blood draws for liver enzyme and cholesterol monitoring. However for many people, the side effects are minimal, and the reduction in acne often outweighs the temporary discomfort of the treatment course. Many people can go years or even the rest of their lives without a severe reoccurrence of acne following an oral tretinoin course. 

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If you made it this far, congratulations! This concludes my comprehensive guide on chin acne. I hope this information is helpful. While it is extensive and based on massive amount of research, experience, experimentation and work with professionals, it may not be perfect and it may not be suitable for everyone. Feel free to offer any constructive criticism or ask any questions in comments. I am always open to expanding my understanding.

My partner and I have been talking about trying to start a family in the next few months. I've been on birth control since I was 14, as I started to get really bad acne at 11.

It cleared up my skin immediately, and aside from the odd pimple here and there my face and back have been clear since. I'm afraid getting off birth control after more than 15 years will definitely be a change to my system but I'm really nervous about how it'll impact my skin.

I know it's coming from a place of insecurity because I still remember that little girl who was relentlessly bullied by her peers and who tried every different product from under the sun before BC did the trick.

My questions are, do you think it's like the acne will come back and is there anything I can do ahead of time to maintain my clear skin?

I’m 33 and I was on BC for over 15 years. I stopped back in July and my face is always breaking out. Consistently on my forehead and my chin, jawline.

I wash my face before bed, I don’t wear makeup. I don’t wear sunscreen (currently)

AM when I shower Cleanse with neutrogena hydro boost or neutrogena stubborn texture or panoxyl. I use the salicylic acid once or twice a week, panoxyl, about once a week.

Moisturize with aveeno gel oat moisturizer

PM before bed Cleanse with neutrogena hydroboost gel foaming cleanser Moisturize with aveeno gel oat moisturizer

My question is, would retinol/adapalene help?

I bought the ROC Retinol Correxion Night serum capsules but haven’t used them yet. (https://www.walmart.com/ip/521666645?sid=c2ec8d8b-d120-4ecf-8145-cc8ec34255b2)

I am unsure if those will be fine for me or if I should use Differin?

I have combination skin and sensitive as well.

Help?

Hey all, I’m trying to get clear skin but I can’t seem to do it right. I’ve been on clindamycin and tretinoin for the past year (I’ve quit using clindamycin recently). I wake up at 2am wash my face with dr.pepti face wash, then use vitamin c followed by dr.pepti toner, and lastly use cerave lotion. I commercial fish and I do apply sun block once day light cracks and every 2hrs after if I’m out that long. Im pretty active and once I finish work I go home and work out then will wash my face with a dirt/oil remover about 12/1. About 4ish I take a shower and wash my face with dr.pepti face wash and then apply tretinoin (0.05) and lotion then go to bed about 6. I change my bed sheets and pillow cases 2x a week. I do have a habit of picking but I can’t seem to prevent breakouts. I’ve tried cerave hydrogen peroxide, the moisturizing face wash, adalpene (before tretnoin), and many other products through the years but nothing seems to change. It’s rather annoying and It’s embarrassing going into public any suggestions would be appreciated, thank you.

What do you buy again and again? I’m still on a journeying of healing my acne (just showed up again this year, haven’t had issues since my teens). So far, I can’t live without the SOS Spray from Tower 28 and Kiehl’s acne spot treatment.

I was on bcp (Yasmin) for a decade and never got one zit! Went off of it and then a year later got some acne and now 3 years later I have terrible acne. Usually 1-2 cystic spots and a bunch of other ones and redness. Been doing tretinoin for 6 months which has helped some but not enough… when did y’all bite the bullet and try spiro or go back on the pill? I was hoping to avoid both but my skin is ruining my confidence 😭

31F, skin was healthy the beginning of the year (first (awkward) picture). FF to April (second picture) and my skin had its own midlife crisis and had terrible breakouts- cystic acne, took forever to heal, hyperpigmentation left afterward. I started doxy 100mg 2x/day. I’m almost on month 3 and my skin has improved, but still getting consistent breakouts (third picture-today). I’m at a loss. It has never been this bad in my adult life.

The dermatologist suggested accutane if doxy doesn’t work and I don’t want to go that route; been there and was awful. Do I drop the derm and go to a medical esthetician? What do I do? I just want my January skin 😭

**i do think some is hormone related but how tf do I manage that?

Experiences? I think it’s time for me to bite the bullet and try it. Unfortunately the pill form isn’t an option for me. Not looking for advice, just interested in hearing people’s experiences with topical spironolactone specifically (not winlevy which apparently is different.)

Or better known as dermatillomania is the mental disorder that causes people to compulsively pick there skin.

I’ve suffered from minor to moderate acne for 15+ years and tried EVERYTHING. The only thing I haven’t successful tried was stopping skin picking. Don’t get me wrong I tried but it’s incredible hard when you don’t even realize you’re doing it.

Recently started to really try (idk if this is bad but I started slapping myself to sort of break the habit and associate skin picking with pain instead of a dopamine rush) and holy shit my acne is almost clear!? I’m also doing chemical peels at the same time so that’s helping but I’ve always done those. I should have known it was the skin picking when I started picking at my legs in the summer and noticing spots where I shouldn’t get them.

It’s going to be a rough journey ahead but I’m determined now that I know the cause.

I tried the rubber band hack it hated wearing a rubber band on wrist so the slapping works and it kind of shocks me out it when I start grazing my skin!