If your acne breakouts return before your period, concentrate around your chin and jawline or persist despite a consistent skincare routine, you may suspect a hormonal influence.
During a consultation, I consider those factors carefully. The timing and distribution can provide useful clues, but they are only part of the diagnosis.
As a dermatologist, I also assess the depth of inflammation, the types of lesions present, your medical history and your response to previous acne treatment. Together, these findings help me establish what is sustaining the acne and which approach I should prescribe.
For adult women, that distinction matters. A treatment plan should account for both the skin’s visible presentation and any relevant hormonal or medical factors.
Understanding the Hormonal Influence on Acne
“Hormonal acne” is commonly used to describe acne influenced by hormonal activity, particularly the effect of androgens on the sebaceous glands.
These glands produce sebum, the skin’s natural oil. Hormonal activity can increase their output, contributing to blocked follicles and inflammatory lesions.
An underlying hormonal disorder is not present in every case. Some women have elevated androgen levels; others experience acne while their circulating hormone levels remain within the expected range. The sensitivity of the skin to hormonal activity also plays a role.
If you have previously been told your blood tests are normal, that does not invalidate the pattern you have noticed. I interpret those results alongside your history and examination findings to determine their clinical significance.
Patterns That May Suggest Hormonal Influence
Recurring breakouts before a period, persistent lower-face acne and deeper, tender lesions can suggest a hormonal contribution.
You may also notice acne developing or becoming more active after starting or stopping hormonal contraception, or during another hormonal transition.
These patterns guide my questions, but location alone cannot establish the cause. Acne influenced by hormones may affect the cheeks, forehead, chest or back as well as the jawline.
I examine whether the presentation includes blocked pores, inflammatory spots or deeper nodules. I also consider whether another condition could be producing acne-like lesions, particularly where the pattern or treatment response is unusual.
This prevents a familiar label from narrowing the assessment too early.
When Further Medical Investigation Is Appropriate
Jawline acne alone does not automatically require hormone testing.
If acne occurs alongside irregular or absent periods, increased facial or body hair, scalp thinning or a sudden marked progression, I consider whether further investigation is warranted.
Polycystic ovary syndrome is one condition that can be associated with acne and other signs of androgen excess. Acne on its own does not establish that diagnosis.
Depending on the findings, I may recommend investigations or coordinate care with your GP or another specialist. The purpose is to answer a relevant clinical question and determine whether a broader medical factor should influence treatment.
What I Assess During Your Acne Consultation
Your previous treatment response helps guide what I prescribe next.
I ask which products or medicines you have used, how long you used them, whether they caused irritation and whether improvement persisted after treatment stopped. Photographs may be useful if your skin is relatively settled on the day.
Menstrual patterns, contraception, current medicines, relevant health changes and pregnancy plans also form part of the consultation.
During examination, I assess the extent and depth of inflammation, the areas affected and whether pigmentation or scarring is developing.
An acne consultation brings these findings together. It allows me to identify the immediate priority and explain how each part of the prescription contributes to the intended outcome.
Prescribing a Treatment Pathway
The treatment objectives generally include reducing new lesions, settling inflammation and limiting further marks or acne scarring.
The prescription depends on acne severity, medical circumstances, previous treatment and your preferences. It should also be sustainable within your daily routine.
Topical Treatment and Skin Tolerance
Topical treatment can address blocked follicles, inflammation and other contributors to acne.
I review the surrounding skincare routine at the same time. Several exfoliants or strong active ingredients used together may create irritation without providing additional acne control.
For clients whose skin has become sensitive after repeated product changes, I may first simplify the routine and establish a treatment schedule the skin can tolerate.
I consider both the response and skin tolerance before adjusting the prescription. This is particularly relevant when inflammation or irritation leaves persistent pigmentation.
Medical Treatment
Persistent inflammatory acne, deeper lesions, widespread involvement or developing scars may warrant prescription treatment.
Depending on the presentation, this can include topical or oral therapy. For certain women, an approach that addresses hormonal influence may also be appropriate.
I discuss the expected benefits, limitations, side effects and monitoring requirements before prescribing. Medical history and current medicines affect that decision, as do pregnancy, breastfeeding and plans to conceive.
Some acne treatments cannot be used during pregnancy. Please raise these considerations during the consultation so they can be incorporated into the prescription from the outset.
Laser and Light-Based Treatment for Active Acne
Laser and light-based treatments may form part of an acne treatment plan when their function matches the clinical presentation.
AviClear is a laser treatment that targets sebaceous gland activity. BBL is a light-based technology with protocols that may be used for selected acne presentations. These approaches have different mechanisms, so the recommendation depends on the type of acne, your medical history and previous treatment response.
A hormonal pattern still requires consideration of the wider medical picture. Neither technology investigates an underlying hormonal condition.
During your acne consultation, the potential contribution of in-clinic treatment can be discussed alongside other appropriate approaches, including its limitations, recovery and how progress will be reviewed.
Addressing the Marks Acne Leaves Behind
If each breakout leaves a mark, the complexion can remain uneven even between flares.
I assess these residual changes separately from the active acne. Brown marks may represent post-inflammatory pigmentation. Red or pink marks may reflect vascular changes, while indentations involve the structure of the skin.
Where new inflammatory lesions are continuing, gaining control of that activity is usually an early priority. At the same time, the routine should support skin tolerance and avoid additional irritation.
Once active acne is sufficiently controlled, residual pigmentation, redness and acne scars can be considered separately.
For suitable clients, Moxi laser may have a role in addressing post-acne pigmentation, while BBL light-based treatment may be considered for selected presentations involving persistent redness. Indented acne scars require a separate assessment of their depth and pattern before an appropriate resurfacing or other treatment approach is recommended.
How Treatment Progress Is Reviewed
Acne treatment develops over time. Early improvement may become apparent over several weeks, while a fuller response often takes months, depending on the treatment and severity.
At review, I look for fewer inflammatory breakouts, resolution of deeper lesions and whether new pigmentation or acne scars are developing. Your skin’s tolerance and how comfortably treatment fits into your routine are equally relevant.
The conversation also extends beyond skincare. Sleep, stress, dietary patterns and alcohol intake form part of the wider history. If you have noticed that your acne becomes more active during demanding periods or alongside changes in your routine, those details are worth discussing.
When I review your acne, I am interested in how your skin is responding and what has been happening in your life over the same period. Understanding both helps me refine your treatment with a clearer picture of what may be contributing to persistent flares.
When to Arrange a Medical Assessment
An assessment is appropriate if acne is painful, leaving scars, worsening rapidly or affecting confidence & social decisions.
Acne accompanied by menstrual irregularity, increased facial hair or scalp thinning also warrants medical consideration. Pregnancy or plans to conceive are further reasons to seek advice about treatment suitability.
You do not need to wait until acne is severe. Recurring inflammation, persistent pigmentation or uncertainty about previous treatment can all be addressed during a consultation.
A Considered Plan for Recurring Acne
The pattern you have noticed is valuable information. My role is to place it within the complete clinical picture and determine which treatment pathways are appropriate.
For one client, that may involve topical care. For another, oral treatment, further investigation or selected in-clinic treatment may have a role. The approach is reviewed according to response, tolerance and the relevant medical circumstances.
An acne consultation with Dr Shammi provides the opportunity to establish the contributing factors, discuss realistic treatment objectives and prescribe an individual plan.
General information only. This article does not replace an individual medical assessment. Treatment suitability, risks and outcomes vary between clients.
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