Acne on cheeks: causes, hormones and treatment

Acne on the cheeks is common, and medical sources link it to three things: skin oil, makeup, and anything that touches or rubs the face. Its place on the face cannot tell you whether hormones are the cause, and some bumps on the cheeks are a different condition, such as rosacea or milia. This guide covers the causes the sources name, what studies found about hormones, how to tell cheek acne from its look-alikes, and how the American Academy of Dermatology (AAD) advises treating it. It is part of Skinli's guide to acne by face area.

Skinli gives general education and is not a doctor. This page names no brand. Acne on the nose, chin, lips and jaw has its own guides, linked below where they fit.

What causes acne on the cheeks

Acne starts in a pore. The AAD says: "Acne develops when pores become clogged." On the cheeks, the sources point to these causes.

Skin oil. One research group split the face into two zones: the T-zone (forehead, nose and chin) and the U-zone (both cheeks). In a 2013 study of 914 acne patients, the amount of oil on the skin "markedly influenced the number of inflammatory lesions and the acne lesions located in the U-zone." Inflammatory lesions are the red, swollen spots. In younger patients the link with oil showed on the cheeks, and in older patients it showed in the T-zone. A 2012 study of 878 patients by the same group photographed the face under ultraviolet light, where skin oil glows red. The more the cheeks glowed, the more acne spots they had. The same four authors wrote both studies, so treat them as one group's findings.

Makeup. The AAD calls acne caused by cosmetics acne cosmetica. It says: "If you have acne cosmetica, you'll likely have many tiny bumps on your face. These bumps usually appear on the cheeks, chin, or forehead." The AAD adds that "It can take anywhere from a few days to 6 months for blemishes to appear." That delay makes the cause hard to spot. Foundation, blush and concealer are on the AAD's list of products that can cause it. Sleeping in makeup counts as well: "Even non-comedogenic makeup can cause acne if you sleep in it." The guide does makeup cause acne covers this in full.

Touch and things that press on the cheeks. The AAD says: "Touching your face throughout the day can cause acne to flare." A face mask adds heat and pressure. The AAD advises skipping makeup under a mask, because "Beneath a mask, makeup is more likely to clog your pores and lead to breakouts." Maskne causes and treatment has the rest of that advice. A pillowcase also touches the cheeks every night, and pillowcases and acne covers what the evidence says about it.

The phone. A 2020 letter from India described 13 patients seen by video call. They had more acne, or worse acne, "on the side of the face that came in most frequent contact with a cell phone while talking". Thirteen people is a small group, and the authors gave their reasons as guesses.

Is acne on the cheeks hormonal?

Location alone cannot answer that. Here is what the studies found, and they do not all agree.

Study	Who	What it found about the cheeks
2021 clinic study	208 women aged 25 or older, examined by dermatologists	Cheeks were the most common site (87.0 percent), then the area around the mouth (81.7 percent)
2014 study in France and sub-Saharan Africa	Women aged 25 or older at hospital clinics in Créteil, Dakar and Bamako	Cheek and forehead acne was more common in women with darker skin. Chin acne was more common in women with lighter skin
2018 review	Adult women with acne	Says acne often sits on the lower third of the face and the sides of the neck

The 2021 study put the cheeks first, the 2018 review points lower on the face, and the 2014 study found that the pattern changed with skin color. In the 2021 study, the women were checked for polycystic ovary syndrome (PCOS), a hormone condition. The factors linked to PCOS were younger age, acne that flared before periods, and irregular periods. The study did not link cheek acne to PCOS. The 2018 review adds that most adult women with acne have no hormone disease that could cause it.

So look at the whole body. The AAD says women with PCOS "usually have other signs of a hormone problem, such as hair loss on their head, noticeable hair growth on their face". It also lists irregular periods. If you have those signs as well as acne, see a doctor. The PCOS acne guide and the adult acne guide go further. The AAD also says that 20 to 40 percent of women with adult acne first get acne as adults.

Bumps on the cheeks that may be something else

Some cheek bumps look like acne and need different care. A dermatologist can tell them apart, and these are the main ones the sources describe.

Rosacea. The AAD says: "A skin condition called rosacea can cause acne-like breakouts and redness." Its clue is that "The acne-like breakouts usually appear where you have redness on your face." The NHS lists, among the first signs, "redness (blushing) across your nose, cheeks, forehead, chin, neck and chest that comes and goes", and a burning or stinging feeling with water or skin care products. It adds: "You may get small pink or red bumps on your face, sometimes filled with a yellowish liquid, if you have rosacea." Rosacea vs acne explains the differences.

Milia. The American Academy of Ophthalmology says milia are tiny white bumps that often form on the cheeks, the nose and the eyelids. People sometimes take them for whiteheads, but the academy says milia cause no itching and no pain. MedlinePlus, the US National Library of Medicine's health site, says milia form when dead skin gets caught in tiny pockets near the skin's surface, that adults can get them on the face, and that they are a separate condition from acne. What is milia covers them.

Contact dermatitis. This is a rash from something that touches the skin. The AAD says "The face, neck, underarms, scalp, and tops of feet are also common places to develop contact dermatitis." Nickel is a common cause, and the AAD says this metal "is also found in cell phones, laptops, and other tech devices."

What you see on the cheeks	What it may be	Source
Many tiny bumps after starting a new makeup product	Acne cosmetica	AAD
Pink or red bumps where the face flushes, with burning or stinging	Rosacea	AAD, NHS
Tiny, hard white bumps that do not hurt	Milia	American Academy of Ophthalmology
An itchy rash where a product or a device touches	Contact dermatitis	AAD
Blackheads, whiteheads and pimples together	Acne	AAD

How to treat acne on the cheeks

Find what touches your cheeks. The AAD's advice for acne cosmetica is to read the labels of your makeup, skin care and hair care products and stop the ones that may clog pores. It says: "Make sure you see one of the following terms on your products: Oil-free, won't clog pores, or non-comedogenic." Non-comedogenic means made so it does not block pores. The AAD also advises cleaning makeup brushes every week and using only your own. It says that "Acne cosmetica tends to clear once you stop using what's causing it."

Use an acne treatment on the whole area. The AAD says: "To unclog pores, dermatologists recommend using a retinoid. You can buy one retinoid, adapalene, without a prescription." Its acne cosmetica page also names benzoyl peroxide and salicylic acid. Do not dab it only on the spots you see. The AAD says to "spread a thin layer of the acne medication evenly over your acne-prone skin." If your acne sits on both cheeks, treat both cheeks. How to start adapalene explains the first weeks.

Wash gently. The AAD says: "Gently wash your face up to twice daily and after sweating." It also says to avoid products that can irritate the skin, "including astringents, toners, and exfoliants."

Leave the spots alone. The NHS says "do not pick or squeeze spots because this can cause scars". The AAD adds that popping brings a risk of "getting an infection from the bacteria on your hands." Should you pop a pimple explains why.

Give it time. The AAD's acne cosmetica page says: "It can take 4 to 8 weeks to see some improvement." Its page on treating acne says to "Give treatment six to eight weeks to work." Skinli's own plan pages use 8 to 12 weeks for skin to change.

Deep or painful bumps on the cheeks

A deep pimple on the cheek can be a nodule or a cyst. The AAD says that because these breakouts go deep into the skin, "they can feel tender or painful." For one deep pimple, the AAD advises a warm compress: "Soak a clean washcloth in hot water, then apply the warm, damp washcloth to your pimple for 10-15 minutes, three times daily." It says a hydrocolloid acne patch, a small sticker that covers the spot, "can be applied to protect your skin and improve healing." The blind pimple guide covers a lump that has not come to a head.

Many deep breakouts need a dermatologist. The AAD says treatment for deep breakouts such as acne cysts "requires prescription medication." The cystic acne guide covers those choices.

See a doctor or a dermatologist when:

• acne on the cheeks has not improved after six to eight weeks of steady treatment,
• you have deep, painful lumps, or acne is leaving scars or dark marks,
• red bumps come with flushing, burning or stinging, which can mean rosacea,
• you also have irregular periods, new hair growth on the face, or hair loss on the head.

Get medical help soon if a spot becomes hot, swollen and red. The NHS lists "hot, swollen and red skin" as signs of a skin infection.

Acne on other parts of the face has its own pages: forehead and chin acne, jawline acne and pimples on the nose.