PCOS, or polycystic ovary syndrome, is a common endocrine disorder among women during their reproductive years. It is characterized by enlarged ovaries that fail to produce fertile eggs. Apart from infertility, the condition also causes skin problems, such as thinning hair, skin tags, eczema, and acne.
This article focuses on PCOS acne, explaining how the condition leads to breakouts, and recommends practical solutions for acne management.
What Is PCOS Acne?
PCOS acne is a common symptom of polycystic ovary syndrome, typically affecting women from puberty to menopause. It is estimated that 40-60% of PCOS patients experience hormonal acne. PCOS acne is persistent, recurring, and often accompanied by inflammation. The lesions tend to be deep and take a long time to resolve.
How Does PCOS Cause Acne?
Medical professionals suspect polycystic ovary syndrome causes acne through several mechanisms.
Excess Androgens
Increased production of androgen (male) hormones is a defining feature of PCOS. The condition causes higher levels of luteinizing hormone (LH), which leads to a surge in androgen production. Excess androgens, in turn, trigger sebum overproduction, which is one of the primary factors contributing to the development of acne.
Insulin Resistance
Most PCOS patients have insulin resistance. It is a condition that makes body cells unresponsive to insulin, the hormone that facilitates glucose uptake from the blood for essential bodily functions. The body then produces more insulin to ensure glucose transport into cells, which causes increased production of basal keratinocytes (cells responsible for skin regeneration). Abnormal keratinocyte activity can lead to clogged pores and acne formation.
Inflammation
Chronic inflammation is frequently found in PCOS patients. It also contributes significantly to the development of acne, which is categorized as an inflammatory skin condition. Elevated levels of inflammatory cytokine interleukin 6 (IL-6), frequently found in PCOS patients, are often associated with increased activity of Cutibacterium acnes, the bacterium that causes acne.
Common PCOS Acne Features
PCOS acne usually occurs on the lower face (chin, jawline), chest, and back. Some of the characteristics of PCOS acne include the following:
- More severe than other acne types
- Red and inflamed papules
- Deep and painful cysts
- Persistent and recurring
Diagnosing PCOS Acne
A dermatologist may suspect the root cause of the patient’s acne is a hormonal issue if the patient has common PCOS acne symptoms and if the usual acne treatments, including topical retinoids, benzoyl peroxide, salicylic acid, etc., are ineffective.
A PCOS diagnosis requires more than a skin evaluation. The doctor will perform other examinations, such as a blood test to establish hormone levels and an ultrasound to check for polycystic ovaries.
PCOS Acne Management
PCOS-related acne can only be managed by treating the underlying hormonal imbalances, insulin resistance, and inflammation. Doctors prescribe different medications and supplements depending on the patient’s unique symptoms. They also recommend an anti-inflammatory diet and proper skincare to support pharmacological solutions.
Birth Control Pills
Doctors frequently use estrogen-progesterone birth control pills to manage the patient’s hormonal acne. These birth control pills typically combine ethinyl estradiol with a synthetic form of progesterone, such as drospirenone, desogestrel, or progestin norgestimate. They help lower androgen activity and manage other PCOS symptoms, such as irregular menstruation.
Not all patients are suitable for this therapy. A medical provider may recommend other medications if a patient is older than 35, smokes, or has any of the following:
- Breast cancer or a history of breast cancer in the family
- High blood pressure
- Heart disease
- Problems with blood clotting
- Obesity
- Diabetes
- Liver or gallbladder problems
Anti-Androgen Drugs
High testosterone is often the primary cause of acne in PCOS patients. If blood tests show raised androgen levels, doctors may prescribe androgen-lowering drugs, such as:
- Spironolactone
- Cyproterone acetate
- Finasteride
- Flutamide
When patients have severe hyperandrogenism and persistent acne, doctors combine anti-androgen medications with birth control pills, oral antibiotics, and other acne treatments.
Metformin
Metformin is indicated for the treatment of type 2 diabetes and high blood sugar. Doctors prescribe it to insulin-resistant PCOS patients because it improves insulin sensitivity and decreases androgen levels.
Oral Isotretinoin
Oral isotretinoin is a prescription medication for severe hormonal acne. It is often prescribed when topical retinoids, antibiotics, or hormonal treatments aren’t effective. Isotretinoin significantly decreases sebum production, bacterial growth, and inflammation, helping to clear acne.
However, isotretinoin use increases the risk of adverse effects, such as hormonal, psychiatric, and metabolic problems. Medical providers carefully evaluate the potential risks and benefits before prescribing isotretinoin to patients.
Anti-Inflammatory Diet
Foods that promote inflammation can counter the effects of medications and exacerbate breakouts. Inflammatory foods include red meat, white flour bread and pasta, and foods that are processed, deep-fried, and high in sugar.
PCOS patients experiencing persistent acne should adopt an anti-inflammatory diet based on fiber and antioxidant-rich foods from the following list:
- Leafy greens (kale, spinach, lettuce)
- Tomatoes
- Cauliflower
- Peppers
- Sweet potatoes
- Legumes (beans, lentils, chickpeas)
- Almonds
- Walnuts
- Berries
- Apples
- Pears
- Avocadoes
- Olive oil
- Whole grains (barley, oats, quinoa)
Gut-Supporting Supplements
Emotional stress, environmental aggressors, and poor lifestyle habits can deplete beneficial bacteria and lead to an overgrowth of harmful microorganisms in our gut. Gut dysbiosis can cause further health complications, including inflammation, insulin resistance, and hormonal imbalances.
Certain supplements support other PCOS and hormonal acne treatments by helping to regulate microbial imbalance and reduce associated medical concerns.
Our medical professionals at Vibrant Skin Bar recommend the following natural products for gut health management.
- Vibrant Gut Support – Protects the integrity of the gut lining, promotes healthy intestinal function, and improves gut-associated immune function.
- Vibrant Biome – Improves the bacterial diversity in the gut and supports a healthy gastrointestinal function.
- Osmosis Digestive Support – Assists the breakdown of essential nutrients, helping maintain a healthy gut and clear skin.
Proper Skincare Routine
Medications and an anti-inflammatory diet address the root causes of PCOS acne, but poor hygiene can make the treatments ineffective. Since hormonal imbalances and inflammation can clog pores, it is vital to adopt a good daily skincare routine with gentle, non-comedogenic cleansers, acne serums, and moisturizers.
Vibrant is a collection of microbiome-friendly, blemish-controlling products for complete daily skin care. Here are our recommendations on how to treat your skin if you suffer from PCOS acne:
- Cleanse the skin thoroughly in the morning and evening with Vibrant Cleanse, a biome enzyme cleanser for all skin types.
- Tone and tighten pores with Vibrant Toner, a clarifying biome toner.
- Apply Vibrant Defense, our blemish clarifying serum, to reduce oil production, balance skin flora, and minimize pores.
- Follow with Vibrant Restore, a soothing moisturizer designed to balance oils, hydrate the skin, and strengthen the skin barrier.
- Occasionally use mud masks and spot-on treatments to unclog pores, detoxify the skin, and clear blemishes.
- Avoid picking and scratching acne.
Conclusion
Acne is a common symptom in patients with polycystic ovary syndrome. PCOS acne is often more persistent and difficult to resolve than other hormonal acne and it requires treating the underlying cause, such as excess androgen and insulin resistance. Seeking help from a medical professional and an accurate diagnosis increases the chance of finding an effective treatment.
