Hormonal acne is driven by androgens, so topicals alone — tretinoin, salicylic acid, benzoyl peroxide — only treat the surface clog while your ovaries keep producing the trigger. Most patients need a systemic approach: oral spironolactone (typically 50 to 100 mg daily) blocks androgen receptors, and combined oral contraceptives suppress the hormonal cycle that flares your chin and jaw every month. Expect 60 to 80% improvement after two to three months of consistent use; full clearance often takes five to six months. If tretinoin alone hasn't worked after 12 weeks, see a dermatologist about adding spironolactone or, for severe scarring cystic acne, isotretinoin. Patches manage individual spots — they don't fix the hormonal driver.