Tretinoin treats clogged pores and turnover but does not lower androgen-driven sebum. If breakouts cluster on the chin and jaw and time with your cycle, the cause is hormonal. Tretinoin alone won't clear it. Adding spironolactone (50 to 100 mg daily) or a combined oral contraceptive shows full results at 8 to 24 weeks. Inflammation also needs antibacterial coverage; pair tretinoin at night with 2.5 to 5% benzoyl peroxide in the morning to hit Cutibacterium acnes. For active cysts during a flare, a ZitSticka Killa microdart delivers 2% salicylic acid beneath the surface. If you've used tretinoin consistently for 12 weeks without change, book a dermatologist for hormonal workup.