Jawline Acne: Causes and Treatment

Primary Causes

Jawline acne is predominantly hormonally driven, particularly by androgens that stimulate sebum production and follicular hyperkeratinization. 1

Hormonal fluctuations are the most common trigger, especially in women with premenstrual flares, polycystic ovary syndrome, or elevated androgen levels 2
Endocrine disorders including PCOS, Cushing syndrome, congenital adrenal hyperplasia, and androgen-secreting tumors can manifest as jawline acne 2
Medications such as testosterone, progesterone, steroids, lithium, and phenytoin may induce acneiform eruptions in this distribution 2
The jawline location strongly suggests a hormonal component, as this pattern is characteristic of adult female acne 1

Start with topical retinoid (adapalene 0.1-0.3% preferred) combined with benzoyl peroxide 2.5-5% as the cornerstone of treatment. 1

Apply adapalene nightly to completely dry skin after waiting 20-30 minutes post-cleansing 3
Apply benzoyl peroxide in the morning, or use a fixed-combination product 1
Adapalene is superior to tretinoin for tolerability while maintaining equivalent efficacy, and can be applied with benzoyl peroxide without oxidation concerns 1, 4
Daily sunscreen is mandatory due to photosensitivity risk 1, 3
This combination targets comedones, microcomedones, and inflammation while preventing bacterial resistance 1, 5

For female patients with jawline acne, add spironolactone 25-200 mg daily or combined oral contraceptives as first-line hormonal therapy. 1

Spironolactone is particularly effective for hormonal acne patterns, premenstrual flares, and jawline distribution 1
- Start at 25-50 mg daily and titrate up to 100-200 mg daily based on response 1
- No potassium monitoring is needed in healthy patients without risk factors for hyperkalemia 1
- Can be used as monotherapy or combined with topical agents 1
Combined oral contraceptives reduce inflammatory lesions by 62% at 6 months 1
- Effective as monotherapy or combined with topical retinoids 1
- Consider as first-line if contraception is also desired 1
Clascoterone (topical anti-androgen) is a newer option that may be particularly relevant for androgen-driven jawline acne 6

For moderate inflammatory acne: Add topical antibiotic (clindamycin 1% or erythromycin 3%) combined with benzoyl peroxide, never as monotherapy 1

Fixed-combination products (clindamycin 1%/BP 5% or erythromycin 3%/BP 5%) enhance compliance 1
Always combine antibiotics with benzoyl peroxide to prevent rapid resistance development 1

For moderate-to-severe inflammatory acne: Add oral doxycycline 100 mg daily to the topical retinoid + benzoyl peroxide regimen 1, 7

Doxycycline is strongly recommended as first-line systemic antibiotic with moderate evidence 1
Limit oral antibiotics to 3-4 months maximum to minimize resistance 1, 7
Always use benzoyl peroxide concurrently with oral antibiotics 1
Counsel about photosensitivity risk with doxycycline 7

For severe, scarring, or treatment-resistant acne: Consider isotretinoin 0.5-1.0 mg/kg/day 1, 7

Indicated for severe acne, treatment-resistant moderate acne after 3-4 months of appropriate therapy, or any acne with scarring or significant psychosocial burden 1
Target cumulative dose of 120-150 mg/kg 1
Monitor liver function tests and lipids, but CBC monitoring is not needed in healthy patients 1
Mandatory pregnancy prevention through iPledge program for persons of childbearing potential 1

Continue topical retinoid monotherapy indefinitely after achieving clearance to prevent recurrence. 1, 7

Adapalene 0.1-0.3% or tretinoin 0.025-0.1% are preferred maintenance agents 7
Benzoyl peroxide can be continued as adjunctive maintenance 1
Hormonal therapy (spironolactone or oral contraceptives) should be continued long-term if effective 1

Never use topical or oral antibiotics as monotherapy - resistance develops rapidly without concurrent benzoyl peroxide 1, 7
Never extend oral antibiotics beyond 3-4 months without re-evaluation - this dramatically increases resistance risk 1, 7
Do not underestimate severity when scarring is present - this warrants more aggressive treatment regardless of lesion count 1, 6
Avoid harsh scrubbing or over-washing - wash gently with mild soap 2-3 times daily maximum 3
Do not apply tretinoin with benzoyl peroxide simultaneously - oxidation inactivates tretinoin; use adapalene instead or separate application times 1

Consider endocrinology consultation if acne is resistant to conventional therapy or if clinical features of hyperandrogenism are present (hirsutism, irregular menses, virilization) 6
Evaluate for underlying endocrine disorders including PCOS, Cushing syndrome, or androgen-secreting tumors in resistant cases 6, 2