From Kavitha R., community member:

I had the exact same thing at 43 — deep, cystic, painful spots right along my jawline and chin, exactly where teenagers get them, which felt particularly unfair at my age. They were worse in the two weeks before my period (when they arrived at all — my cycles had become unpredictable). I was mortified and tried everything I could find at the pharmacy, which mostly made things worse.

When I finally went to a proper dermatologist rather than a general skin doctor, she explained the mechanism clearly. As oestrogen falls in perimenopause, androgens — which are present in small amounts in all women — become relatively dominant. Androgens stimulate oil gland activity, particularly in the lower face: the jawline, chin, and sometimes the neck. The spots are deep, cystic, and slow to heal because they form inside the gland rather than on the surface.

She prescribed an anti-androgen tablet alongside a prescription topical cream applied at night. Within eight weeks my skin was clearer than it had been in years. It took four months to be truly clear, but the trajectory was visible from six weeks.

The key things I would tell you: don’t use harsh scrubs or aggressive physical exfoliants on cystic acne — it does not help and it causes inflammation and scarring. And please see a dermatologist rather than treating this with pharmacy guesswork. This is a hormonally-driven skin condition that responds to specific treatment, and you deserve effective help for it.