Spironolactone plus tretinoin is the standard adult hormonal-acne combo for women — spironolactone blocks androgens at 50 to 100 mg per day, tretinoin 0.025 to 0.1% prevents clogged pores. Most dermatologists start at 25 mg spironolactone and titrate up over 6 to 12 weeks, with full clearance typically by month four. Combined oral contraceptives with norgestimate, drospirenone, or norethindrone acetate are FDA-approved alternatives. For chin and jaw flares, a microneedle patch like Rael Microcrystal or ZitSticka KILLA handles individual lesions between visits. Topical-only routines without spironolactone tend to underperform on cycle-linked breakouts. Severe cases move to oral isotretinoin. Skip OTC products like azelaic acid alone if cysts are involved.