The areas of the face that are most susceptible to acne tend to shift as a woman’s hormones change through the years.

Acne breakouts are not a sight anyone wants to see when they look in the mirror, but understanding the cause of your breakouts can help give you insight on how to better manage your skin. The location of breakouts on the face usually depends largely on the age and hormonal influence of the patient. Adolescents, teenagers in particular, and adult women are the most prone to acne flare-ups. These breakouts occur primarily in two places: the T-Zone and the V-Zone.

Adolescents breakouts often occur in the T-Zone. This area is found by making a T across your forehead and down the nose to the chin. Skin in that area will be oily, shiny and clogged due to the surge of hormones that stimulate the oil glands slightly before and during puberty. These breakouts will display more blackheads and whiteheads. The scalp also produces excess oil during puberty, so natural oils from the hair can cause breakouts as well.

As a person ages, the location of the acne migrates downward, especially for women. Adult women tend to have more of their breakouts on the lower half of the face, which is referred to as the V-Zone. This area covers the lower cheeks, jaw line, chin and neck. The lower part of the face has more hormonal receptivity, which is the primary cause for this shift in location. For instance, women will often get a cyst on their chin the week prior to their menstrual cycle. Post-adolescent women tend to have an inflamed type of acne consisting of pink and white bumps rather than the oily, shiny face you would see in a teenager. The skin is often more normal, or it may even be dry.

In terms of medical conditions, hormonal endocrine problems such as cystic ovaries or overactive adrenal glands can cause hormonal types of acne. In these situations, hormonal acne would occur all the time as opposed to just prior to the menstrual cycle. If a woman is showing a lot of acne and isn’t responding to treatments, a hormonal abnormality is a possible cause. A blood test is necessary in order to diagnose any hormonal imbalance.

An overactive thyroid can also be a medical condition that causes increased acne everywhere, not just in hormonal areas. A thyroid condition will leave the skin shiny and clogged, very similar to adolescent acne. If you’re having a medical condition that is leading to acne flare-ups, you are more likely to find acne on the body as well.

Pay attention to hair and beauty products that you use, such as conditioners and heavy moisturizers, as these can also cause breakouts. Prescribed medications for acne typically come in two types—topical and oral. Topical medications are usually prescription retinoids and topical antimicrobials. Oral medications are antibiotics and hormones, such as the birth control pill. Consult your dermatologist to determine the medication if you think you may need treatment.

Dr. Diane S. Berson, M.D., FAAD, is an associate professor of dermatology at Weill Cornell Medical College. With a focus in medical, surgical and cosmetic dermatology, Dr. Berson has appeared in numerous media outlets including The Wall Street Journal, The New York Times, NBC’s Today Show and CNN Headline News among others. She speaks regularly at national dermatology conferences.