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PCOS Acne: Causes and How to Treat (Ultimate Guide)

Polycystic Ovary Syndrome (PCOS) is a condition affecting your hormonal balance, metabolism, and overall health. It is often associated with a range of symptoms, including hair loss, rapid weight gain, and acanthosis nigricans plus hormonal acne. Distinct from common acne, the blemishes that occur with PCOS acne are often linked to hormonal imbalances, and as such, they require a different approach to treatment and management.

If you have PCOS, you might notice that your skin is more prone to severe acne, particularly along the jawline, cheeks, and chin. This is because the hormonal fluctuations characteristic of PCOS can increase oil production, leading to more clogged pores and breakouts.

Tackling PCOS acne effectively may involve a holistic approach, ranging from medical treatments to lifestyle changes that can help manage hormonal fluctuations and improve skin health.

Key Takeaways

  • PCOS Acne is linked to the hormonal imbalances caused by Polycystic Ovarian Syndrome.
  • Effective management requires a multi-faceted approach, including medical evaluation and lifestyle changes.
  • Hormonal treatment, combined with proper skincare, can significantly improve the condition.

Understanding PCOS and Its Impact on Skin Health

Polycystic Ovary Syndrome (PCOS) is a hormonal disorder that can significantly influence your skin health. A key characteristic of PCOS is a hormonal imbalance, particularly an excess of androgens such as testosterone. These hormones can cause your skin’s sebaceous glands to produce more oil, leading to acne.

Elevated levels of androgens disrupt the natural balance of your hormones, potentially triggering skin-related symptoms. These male hormones, found in higher levels in people with PCOS, are direct contributors to acne development. Conversely, a relative lack of estrogen can also worsen acne symptoms.

According to a study that included data from over 240,000 people with PCOS, it is estimated that the prevalence of acne is 42% in adults with PCOS and 59% in teens with PCOS.

The Connection Between Hormones and Acne

Your skin’s health is directly impacted by hormonal imbalances, particularly those involving androgens such as testosterone. This hormonal activity can contribute to the development of acne, especially in individuals with PCOS.

Role of Androgens

Androgens, which include hormones like testosterone, play a pivotal role in the development of acne. These hormones can cause an increase in oil production from the sebaceous glands, which can lead to clogged pores and acne lesions.

In people with PCOS, androgens are often present at higher levels, making acne one of the possible clinical expressions of this hormonal imbalance. Testosterone is a type of androgen that can increase sebum production and contribute to acne.

Influence of Oestrogen and Progesterone

On the other hand, hormones like oestrogen and progesterone can also affect your skin. Oestrogen is known to have a regulatory effect on oil production, and variations in its levels throughout your menstrual cycle may impact acne.

During the luteal phase, when progesterone levels are higher, your skin might become oilier and more prone to breakouts.

Diagnosis and Medical Evaluation

When you suspect you may have PCOS-related acne, a thorough diagnosis and medical evaluation are crucial. This will encompass recognising symptoms characteristic of PCOS, seeking a dermatologist’s expertise, and understanding the link between cystic acne and PCOS.

Recognising Symptoms

Look for persistent acne that primarily affects the lower third of the face, jawline, and upper neck. These breakouts are often resistant to conventional acne treatments.

In addition, people with PCOS may experience irregular menstrual cycles and excessive facial hair, both of which suggest an excess of androgens—a hormone imbalance commonly associated with the condition.

Consulting a Dermatologist

Should you notice persistent acne alongside symptoms like excessive hair growth, it’s important to consult a dermatologist. They are qualified to identify the relationship between your skin condition and PCOS.

Dermatologists may perform a detailed physical exam and recommend serum androgen level blood tests, which measure hormones like testosterone, to confirm or rule out hyperandrogenism, a hallmark of PCOS. They should understand your medical history and be able to advise on the best way to manage your acne. 

Cystic Acne and PCOS

Cystic acne is a severe form of acne commonly seen in people with PCOS and may indicate androgen excess.

If you’re encountering large, painful, and deep-seated blemishes, particularly on the lower face, you may be experiencing cystic acne associated with PCOS. In such cases, a combination of topical and systemic treatments, including the possible addition of oral combined oestroprogestins or spironolactone, might be suggested by your dermatologist.

How to Treat PCOS Acne

Treating acne associated with polycystic ovary syndrome (PCOS) often requires a multi-faceted approach, addressing not only the skin’s appearance but also the underlying hormonal imbalances. To target high androgen levels (such as high testosterone levels) various medications, supplements, nutrition approaches and stress management techniques may be helpful to manage PCOS symptoms like acne.

General Medication Options

Birth Control: Oral contraceptives are a common first-line treatment for managing PCOS acne. Birth control pills, especially those containing both oestrogen and progestin, can help lower androgen levels and regulate menstrual cycles, leading to clearer skin. Oral contraceptive pills can be hit and miss regarding acne, and unfortunately, it can take some time to figure out which birth control works for you and your symptoms.

Spironolactone: As an androgen receptor blocker, spironolactone decreases oil production in the skin, which can significantly reduce acne in people with PCOS who are not planning a pregnancy.

Metformin: This medication, traditionally used to treat type 2 diabetes, has been found to improve insulin sensitivity in PCOS patients, which may in turn reduce acne severity. A systematic review and meta-analysis suggest that metformin, either as a solo or adjuvant therapy, is linked to a decrease in acne scores among PCOS patients.

Topical and Oral Medications

When managing PCOS-related acne, your treatment plan may include a combination of topical applications and oral medications to target the acne effectively.

Retinoids

Retinoids are powerful derivatives of vitamin A that regulate skin cell turnover and help prevent the plugging of hair follicles.

Your healthcare provider may prescribe topical retinoids, which can decrease the formation of blackheads and whiteheads. These medications come in various forms like gels and creams, and the most commonly known is tretinoin.

Be mindful that retinoids can cause skin irritation, and it’s important to use them exactly as prescribed.

Antibiotics for Inflammation

Oral antibiotics are often utilised to reduce inflammation and bacteria associated with acne.

Medications such as doxycycline or minocycline can be effective, especially for moderate to severe acne.

Antibiotics are typically used short term to decrease the risk of developing resistance. Combining topical treatments with oral antibiotics can lead to better results.

The Efficacy of Benzoyl Peroxide

Benzoyl Peroxide is a well-established topical treatment that works by killing bacteria and clearing pores. It’s available over the counter in various strengths.

Consistent use of benzoyl peroxide can significantly reduce the severity and number of acne lesions. As it can be drying, it’s recommended to start with a lower concentration and increase as your skin tolerates.

Supplements

Supplements may offer support in managing your acne by targeting specific deficiencies and hormonal imbalances. Two supplements that have been highlighted for potential benefits are Inositol and Zinc.

Inositol

Inositol plays a role in insulin regulation, which is particularly relevant in managing PCOS. These supplements come in various forms. One prominent type often studied in conjunction with PCOS is myo-inositol. Research indicates that it can help improve insulin resistance, a common concern in PCOS that can influence acne development. A small study found that myo-inositol supplementation for 3 months reduced acne in people with PCOS. This study is small, but the results are promising.

Zinc

Zinc is an essential mineral with anti-inflammatory properties, making it a candidate for alleviating the symptoms. It’s known to aid in wound healing, and immune function, and may also help to regulate hormone levels.

Low zinc levels can be supported by supplementing, which may help you achieve clearer skin. However, it’s crucial to consider appropriate dosages, as too much can disrupt the absorption of other important minerals.

Foods for PCOS Acne

In managing PCOS-associated acne, your focus on anti-inflammatory foods could be beneficial. Including specific nutrients like Vitamin A, Vitamin C, Vitamin D, Calcium, Copper, Zinc, and certain plant extracts in your diet may support your skin health.

Vitamin A

Vitamin A plays a pivotal role in skin repair and maintenance. Foods rich in this vitamin, such as carrots, sweet potatoes, and spinach, can promote a healthier skin barrier function and are useful in an acne diet for PCOS.

Vitamin C

Not only is Vitamin C essential for immune function, it also supports skin health by boosting collagen production. Including citrus fruits, berries, and kale in your diet can contribute to reducing the appearance of acne.

Vitamin D

Low levels of Vitamin D have been associated with various skin conditions, including acne. Consuming fortified foods or getting moderate sun exposure can boost your levels of this important vitamin, which has potential anti-inflammatory effects.

Calcium

Calcium contributes to normal skin cell turnover, which is crucial in preventing clogged pores. If you are concerned about dairy and PCOS, it is important to mention that the current research we have is not conclusive. A review found that fat-free and low-fat dairy foods did impact ance development, but this study was not in people with PCOS. Read more about PCOS and dairy here.

Copper

Copper aids in the development of collagen and elastin. Nuts, seeds, and leafy greens are excellent choices to ensure an adequate intake of copper.

Zinc

Zinc is known for its ability to regulate oil production in the skin and support the immune system. Sources like pumpkin seeds, lentils, and beef are integral to an acne-reducing regimen.

Turmeric

Praised for its anti-inflammatory properties, turmeric may be helpful for PCOS inflammation and acne. Incorporating this spice into your dishes could be beneficial, but we do need more evidence for turmeric for PCOS.

Garlic

Garlic contains compounds that may assist in reducing inflammation and bacteria associated with acne. Adding garlic to your meals can enhance flavour while offering potential skin benefits.

Bromelain

Bromelain, an enzyme found in pineapples, has been shown to reduce swelling and inflammation. It might be effective as part of a broader approach to managing acne.

Spearmint Tea

Spearmint tea has garnered attention for its possible effects on reducing androgen levels, making it a good consideration for your diet if you’re dealing with PCOS acne. Regular consumption may provide skin benefits.

Natural Treatments for PCOS Acne

If you’re looking to treat your PCOS acne naturally, there are several methods you might consider. It’s important to remember that every person’s body is different, so what works for one individual may not work for another.

You may want to consider lifestyle changes like nutrition tweaks, or supplemeting with inositol and zinc. Drinking spearmint tea could be helpful, or trying natural essential oils like tea tree. Apple cider vinegar is also a common natural remedy for acne (if diluted) although the evidence is poor for its efficacy.

Best PCOS Skincare

Effective management of hormonal changes is crucial for your skincare, especially when dealing with PCOS acne. A tailored skincare routine and understanding the impact of hormonal birth control can help mitigate acne outbreaks.

Choosing the Right Skin Care Routine

Your skincare routine should adapt to the hormonal fluctuations characteristic of PCOS. It is essential to choose products that balance oil production without over-drying the skin.

Start with a gentle cleanser to remove impurities, followed by an oil-free moisturiser to maintain hydration. Non-comedogenic products are your allies, as they won’t clog pores and exacerbate acne.

Morning:

  • Cleanser
  • Oil-free moisturiser
  • Sunscreen (SPF 30 or higher)

Evening:

  • Cleanser
  • Exfoliant (1-2 times per week)
  • Oil-free moisturiser

Consider working with an esthetician or dermatologist to find a skincare routine that improves your PCOS acne.

Frequently Asked Questions

Let’s answer your common questions about PCOS and acne.

What’s the difference between PCOS acne vs regular acne?

PCOS acne typically manifests as more persistent, inflammation-prone, and often concentrated around the lower face, jawline, and neck. Unlike regular acne that might be linked to various factors including hormones, PCOS acne is closely associated with the hormonal imbalances specific to this condition, specifically high levels of androgens.

What treatments are available for managing acne caused by PCOS?

Several treatments may help manage PCOS-related acne, including hormonal therapies to address androgen levels, topical treatments like retinoids, and oral medications such as isotretinoin for more severe cases. Lifestyle modifications and skincare routines tailored to your needs can also play a vital role.

At what age does acne typically present in individuals with PCOS?

Acne in individuals with PCOS may present during adolescence and often continues into adult life. The condition might persist or even start later than typical teenage acne, challenging the notion that acne only affects young people.

What dietary changes can help acne symptoms in PCOS patients?

Dietary changes that may help alleviate acne symptoms include incorporating more vitamins like vitamins A, C and D.

Can acne associated with PCOS resolve on its own without treatment?

Acne associated with PCOS might fluctuate, and in some cases, improve with time. However, due to the underlying hormonal imbalances, it’s less likely to resolve completely without addressing the hormonal imbalances associated with PCOS.

What are the initial indications that acne may be linked to PCOS?

Initial indications that acne might be linked to PCOS include severe breakout patterns, particularly around the jawline and chin, along with other symptoms such as irregular periods, hair thinning on the scalp, and excess hair growth on the body.

Does PCOS cause acne?

Yes, PCOS can cause acne. This is because elevated androgen levels lead to increased sebum production. As a result, more acne breakouts occur. Acne is one of the most common skin-related symptoms people with PCOS experience.

Alex Okell ANutr Founder and Editor

Founder and Editor | Registered Associate Nutritionist

 

Founder of Be The Collective LTD [The PCOS Collective & The Endo Collective] Alex Okell ANutr is a London-based reproductive health nutritionist with experience in research, private practice and digital media. She holds a Master’s degree in Nutrition from King’s College London and has co-authored papers with the University of Cambridge, King’s College London, The Food Foundation and the Food Standards Agency. Alex offers 1:1 PCOS support in our virtual PCOS clinic.

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