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· Breakouts typically occur on the forehead, nose and chin, particularly more common on the lower part of the face, where acne may become stubborn and chronic on the chin and jaw line with resultant scarring and wrinkling on the chin with reddening or pigmentation
· May be due to the hormonal fluctuations of menstrual cycles, pregnancy menopause, hormone replacement
· Adults may develop acne rosacea, particularly over nose and cheeks. Can be mild or severe where there is disfigurement of features such as the nose
· Because adults often have dry or combination skin due to ageing and sun damage, over the counter treatments most often do not really help and generally irritate the complexion.
· Androgens (testosterone) male hormones present in both men and women. A peak in testosterone can cause hormonal breakouts in all age groups
· Hormones enlarge the sebaceous glands increasing sebum production exacerbating plug formation and serves as "food" for bacteria
· Hormone imbalances are a trigger for acne
· Stress causes excess hormone release, worsening acne | 
