Adult female acne, called late-onset acne, is mostly associated with chronic emotional stress leading to increased secretion of adrenal androgens. It has the following characteristics: pre-menstrual flare-ups; lesions distributed on the lower part of the face, including the jaw and chin; increased facial oil; and in some cases, hirsutism. In severe cases, estradiol (E2), dihydrotestosterone (DHT), pituitary luteinizing hormone (LH), and follicle stimulating hormone (FSH) levels should be measured. High androgen levels suggest underlying ovarian or adrenal disease, and an elevated LH/FSH ratio suggests polycystic ovaries.