Adult female acne: looking for the hormonal cause

It tends to sit on the lower face: jawline, chin, neck. The lesions are often deep, inflammatory and painful, and flare in the second half of the cycle.

When it comes with irregular cycles, excess hair growth or hair loss, the possibility of excess androgens — in particular PCOS — must be explored. Treating the skin without exploring that background exposes you to relapse as soon as treatment stops.

The consultation reviews the history of the acne, treatments already tried, contraception and the skincare routine. A hormonal work-up is prescribed when the picture justifies it.

Treatment combines medical management of the acne itself and, where necessary, of the underlying hormonal imbalance. Unsuitable routines, which are common, are corrected: acne-prone skin that has been stripped becomes more reactive and marks more easily.

Once the inflammation is under control, marks and scars can be worked on at the clinic with microneedling or suitable peels — never on acne that is still active.

A distinction must be made between post-inflammatory marks, brown or red, which fade with time and sun protection, and depressed scars, which require specific treatment.

Sun protection is decisive: on acne-prone skin, the sun darkens marks lastingly. It is the first piece of advice given in consultation, before any session.