Hormones

The lower face is rich in androgen-sensitive sebaceous glands. Premenstrual flares are common as luteal-phase shifts (relative rise in progesterone and fall in oestrogen) and increased insulin-like growth factor-1 (IGF-1) amplify sebum and inflammation. Hyperandrogenic states—most notably polycystic ovary syndrome (PCOS)—are frequent in persistent adult acne and often present with chin/jawline lesions, sometimes with hirsutism or menstrual irregularity. Medications that raise androgens (e.g., anabolic steroids) or corticosteroids can provoke acneiform eruptions.

Diet

Diet modulates endocrine and inflammatory pathways that affect follicles.

• High glycaemic load: Rapid glucose/insulin spikes upregulate IGF-1 and mTOR signalling, driving sebum production and hyperkeratinisation.

• Dairy (especially milk/whey): Increases IGF-1 and may deliver androgen precursors; associated in observational data with higher acne risk in susceptible individuals.

• Western dietary pattern: Energy-dense, high in saturated/trans fats and refined carbohydrates, low in fibre and polyphenols—linked to higher acne prevalence.

What helps: Emphasise a low-glycaemic, fibre-rich pattern (vegetables, legumes, whole grains), adequate omega-3s (fish, flax), and polyphenol-rich foods (berries, cocoa, olive oil). Trial reducing milk/whey for 6–8 weeks if acne is stubborn. Avoid excessive iodine supplements (e.g., kelp).

Skincare & Cosmetics

“Acne cosmetica” arises from comedogenic ingredients (e.g., certain heavy oils, isopropyl myristate, some fatty acid esters) and inadequate cleansing. Heavy foundations and powders, plus incomplete makeup removal, increase follicular occlusion—often most evident on the chin.

What helps: Choose non-comedogenic, oil-free products; double-cleanse gently at night; avoid over-scrubbing (irritation worsens acne). Audit hair products that contact the lower face. Change pillowcases frequently.

Lifestyle

Stress elevates cortisol and adrenal androgens; poor sleep dysregulates immune and barrier function. Smoking is associated with a comedonal, treatment-resistant adult female acne phenotype.

What helps: Prioritise 7–9 hours of sleep, regular exercise for insulin sensitivity and stress reduction, and smoking cessation.

Environment & Friction

Ambient air pollution increases oxidative stress in sebum and epidermis, promoting inflammation and comedogenesis. Prolonged occlusion and friction (e.g., tight masks, chin straps) create a warm, humid micro-environment (“maskne”).

What helps: Gentle cleansing after high exposure; consider antioxidant serums (vitamin C/E) and non-comedogenic barrier creams before friction; take mask breaks when feasible and rotate clean, breathable masks.

Gut–Skin & Systems

Emerging evidence links gut microbiota and systemic inflammation with acne severity through metabolic and hormonal crosstalk. While causality is still being mapped, dysbiosis, insulin resistance, and low-grade inflammation are common in PCOS-related acne.

What helps: A Mediterranean-style pattern supporting microbial diversity (fibre, fermented foods where tolerated) aligns with both gut and skin health. Discuss probiotics with your clinician; address IBS/SIBO if present.

Practical Assessment Checklist

• Pattern & timing: Chin/jawline-predominant? Premenstrual flares? Sudden onset?

• Cycle & symptoms: Irregular periods, hirsutism, weight gain → consider PCOS work-up.

• Dietary review: Glycaemic load, milk/whey, sugary drinks, ultra-processed foods.

• Product audit: Swap to non-comedogenic skincare/makeup; improve makeup removal.

• Habits: Hands off chin, sanitise phone, post-workout cleanse, sleep/stress hygiene.

• Environment: Pollution exposure, mask duration/fit, occupational oils/chemicals.

• Medications/supplements: Androgens, corticosteroids, high-dose B12, iodine.

For more precise, personalised advice Choose a Consultation.

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References:

Amuzescu, A. et al. (2024) ‘Adult Female Acne: Recent Advances in Pathophysiology and Therapeutic Approaches’, Cosmetics, 11(3), p. 74. Available at: https://doi.org/10.3390/cosmetics11030074.

Baldwin, H. and Tan, J. (2021) ‘Effects of Diet on Acne and Its Response to Treatment’, American Journal of Clinical Dermatology, 22(1), p. 55. Available at: https://doi.org/10.1007/s40257-020-00542-y.

Branisteanu, D.E. et al. (2022) ‘Adult female acne: Clinical and therapeutic particularities (Review)’, Experimental and Therapeutic Medicine, 23(2), pp. 1–7. Available at: https://doi.org/10.3892/etm.2021.11074.

Bungau, S.G. et al. (2022) ‘Non-conventional therapeutical approaches to acne vulgaris related to its association with metabolic disorders’, European Journal of Pharmacology, 923, p. 174936. Available at: https://doi.org/10.1016/j.ejphar.2022.174936.

Carmina, E. et al. (2022) ‘Female Adult Acne and Androgen Excess: A Report From the Multidisciplinary Androgen Excess and PCOS Committee’, Journal of the Endocrine Society, 6(3), p. bvac003. Available at: https://doi.org/10.1210/jendso/bvac003.

Choi, K. et al. (2025) ‘A Case-Control Study Exploring the Association Between Cosmetic Use and Acne Risk: Implications for Prevention and Clinical Practice’, Clinical, Cosmetic and Investigational Dermatology, 18, pp. 1833–1843. Available at: https://doi.org/10.2147/CCID.S533950.

El Haddad, C. et al. (2021) ‘Association between exposure to ambient air pollution and occurrence of inflammatory acne in the adult population’, BMC Public Health, 21(1), p. 1664. Available at: https://doi.org/10.1186/s12889-021-11738-0.

Zeichner, J.A. et al. (no date) ‘Emerging Issues in Adult Female Acne’, JCAD – The Journal of Clinical and Aesthetic Dermatology. Mount Sinai Hospital, New York, NY. Disclosure: The authors report no relevant conflicts of interest. Available at: https://jcadonline.com/emerging-issues-in-adult-female-acne/ (Accessed: 9 October 2025).

Kutlu, Ö., Karadağ, A.S. and Wollina, U. (2023) ‘Adult acne versus adolescent acne: a narrative review with a focus on epidemiology to treatment’, Anais Brasileiros de Dermatologia, 98(1), pp. 75–83. Available at: https://doi.org/10.1016/j.abd.2022.01.006.

Nast, A. et al. (2016) ‘European evidence-based (S3) guideline for the treatment of acne – update 2016 – short version’, Journal of the European Academy of Dermatology and Venereology, 30(8), pp. 1261–1268. Available at: https://doi.org/10.1111/jdv.13776.

Niedźwiedzka, A. et al. (2024) ‘The Role of the Skin Microbiome in Acne: Challenges and Future Therapeutic Opportunities’, International Journal of Molecular Sciences, 25(21), p. 11422. Available at: https://doi.org/10.3390/ijms252111422.

Penso, L. et al. (2020) ‘Association Between Adult Acne and Dietary Behaviors: Findings From the NutriNet-Santé Prospective Cohort Study’, JAMA Dermatology, 156(8), pp. 854–862. Available at: https://doi.org/10.1001/jamadermatol.2020.1602.

Sánchez-Pellicer, P. et al. (2022) ‘Acne, Microbiome, and Probiotics: The Gut–Skin Axis’, Microorganisms, 10(7), p. 1303. Available at: https://doi.org/10.3390/microorganisms10071303.

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