How can I treat acne around my left jawline and chin?

Question

Hello doctor,

I have really bad acne around my left jawline and on my chin. I believe it is cystic acne because there is no visible head, and it is under the skin. I also have significant scarring from acne on my face, and now my forehead is starting to break out as well.

How can I get rid of my acne and scarring? I tried Differin, but it was very painful during the first month, so I stopped using it. It also caused me to develop chin acne, which I did not have before starting the treatment.

Please advise.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for explaining your concerns so clearly. I understand how upsetting and frustrating painful jawline acne and scarring can be.

Based on your description, the deep, tender, headless lesions on the jawline and chin are very suggestive of cystic or nodulocystic acne, which is common in this area and often has a hormonal component. The new breakouts on the forehead indicate that the acne is becoming more widespread rather than localized.

Differin (Adapalene) is a good acne medication, but it commonly causes initial irritation, purging, and temporary worsening in the first four to eight weeks. The chin breakouts you noticed after starting it were very likely part of this purge phase, not damage. Unfortunately, stopping early often prevents seeing its long-term benefit, but given your description of painful cysts and scarring, topical treatment alone is usually not sufficient.

In moderate to severe inflammatory or cystic acne, oral treatment is often required to control the disease and prevent further scarring. One option is oral Doxycycline 100 mg once daily, which helps reduce acne-causing bacteria and inflammation. It is usually given for a limited duration (eight to 12 weeks) along with topical therapy. Doxycycline should not be used during pregnancy, can cause stomach upset or photosensitivity, and should be taken with plenty of water while avoiding lying down immediately afterwards.

Another option, especially if acne is severe, scarring, persistent, or not responding to antibiotics, is oral Isotretinoin (for example, 20 mg daily). Isotretinoin targets all major causes of acne and is the most effective treatment for cystic acne and the prevention of future scars. However, it has important contraindications and precautions: it must not be used in pregnancy due to severe birth defect risk, requires strict contraception, and needs medical supervision with periodic blood tests. Common side effects include dryness of lips and skin, while serious side effects are uncommon when properly monitored.

Along with oral therapy, topical Benzoyl peroxide gel applied once daily to active acne areas is very important. It reduces bacterial resistance and improves treatment response. A gentle, non-foaming cleanser and a light, non-comedogenic moisturizer should be used to support the skin barrier and reduce irritation.

Regarding scarring, active acne must be controlled first. Once breakouts are under control, treatments such as topical retinoids, chemical peels, microneedling, or laser procedures can significantly improve acne scars, but these are done later and under supervision.

To guide treatment safely and accurately, please share clear photographs of your face (front and side views) and let me know whether your periods are regular, if acne worsens around menstruation, and whether you are currently on any hormonal medication or contraception. With the right combination and patience, cystic acne and scarring can be managed effectively, and your skin can improve significantly over time.

Please get back with the relevant pictures and history so that I can give you an effective management step-by-step plan.

I hope this helps you.

Thank you.