PCOS and acne: How to deal when hormones batter your skin

Being diagnosed with polycystic ovary syndrome (PCOS) is no fun. Not only is PCOS a leading cause of infertility among women but it also brings a stack of frustrating symptoms. One of those symptoms is acne.

Women with PCOS frequently suffer from acne, along with the associated redness, inflammation, and poor skin texture. To make bad matters worse, this type of acne can be stubborn and may not respond to over-the-counter (OTC) treatments. So, how do you cope? To clear up your complexion, you will have to address the underlying PCOS first. We can talk about skincare once that gets sorted.


 What is PCOS?

PCOS is a common hormonal disorder affecting women and girls of childbearing age. Here, the ovaries get enlarged and small cysts may form on them. Sometimes the ovaries may not release eggs on time, which interrupts the ovulation process, leading to irregular menstruation and fertility issues. And this is just the tip of the iceberg!

PCOS can also increase your risk of developing type 2 diabetes, cardiovascular issues, fatty liver disease, and depression. Then there are the visible effects. Many women pack on the kilos because of PCOS and then find it difficult to lose weight. Other tell-tale signs include loss of hair from the scalp and excessive hair growth in areas where hair does not normally grow. Some women also notice dark, velvety skin patches around the armpits, groin, back of the neck, and other areas. Plus, there is the constant struggle with PCOS acne.

The causes of PCOS are not entirely clear, but hormonal imbalances are to blame. When everything is functioning normally, the pituitary gland controls the production of hormones like oestrogen, progesterone, and testosterone. When you have PCOS, it messes with signals sent by the pituitary gland, leading to a drop in the levels of oestrogen and progesterone and a relative increase of testosterone. Women with PCOS have higher-than-usual levels of androgens like testosterone as a result.


How to diagnose PCOS

Your family physician, gynaecologist, or dermatologist will need to assess if you have PCOS. Since there is no single test to confirm a diagnosis, the doctor may ask for blood work and imaging tests.

  • The blood tests will investigate your hormone levels to see if androgen levels are high—a medical condition called hyperandrogenism. The doctor will also examine you for visible signs of hyperandrogenism, such as acne, loss of hair from the head, and excessive hair growth in areas that normally do not have much hair.
  • Imaging tests such as ultrasounds are used to assess the condition of the ovaries. The imaging helps to confirm if the ovaries are enlarged and if any fluid-filled sacs called follicles are present around the eggs.
  • Your doctor may also look for signs of chronic anovulation, where the ovaries do not release an egg during a menstrual cycle. Chronic anovulation may occur when the menstrual cycle lasts beyond 35 days in adults and more than 40 days in teens.

(Hormonal shifts during menstruation can cause acne. Here’s everything you need to know about acne during periods.)


Why does PCOS cause acne?

PCOS messes with hormone levels, and that can play havoc with your skin. Hyperandrogenism is a particular problem here. High androgen levels push the sebaceous glands to produce too much of an oily substance called sebum. Normal amounts of sebum keep the skin supple and lubricated. Too much sebum, however, is a problem.

Excess sebum mixes with dirt and dead skin, creating build-up that blocks the pores. When this happens, acne bacteria get trapped under the skin. The blocked pores create an ideal environment for the bacteria to grow and reproduce. This pushes the body’s immune cells into action, leading to inflammation and acne formation.


What does PCOS acne look like?

PCOS acne appears around the chin, jawline, and upper neck. Basically, it follows the area where a man would have a beard. This is the typical PCOS acne pattern, though some people also notice breakouts on the upper back. If this were regular acne, you would notice blemishes on the forehead and cheeks too.

Acne due to PCOS also feels a little different from standard-issue acne. Instead of bumps on the skin’s surface, you may notice small and painful swellings under the skin. Acne lesions also tend to be deeper, larger, and less likely to respond to OTC treatments. The timing also provides a clue about the type of acne. While non-hormonal acne can show up at any time, PCOS acne tends to flare right before a menstrual period.

The location, feel, and timing of the breakouts offer clues about whether your acne is due to hormonal or non-hormonal causes. If your acne follows the PCOS pattern, ask your doctor whether it could be related to PCOS.

(Dealing with fungal acne? Get tips to treat fungal acne at home.)


Treatment for PCOS acne

Out-of-whack hormones drive acne flares when you have PCOS. Any OTC products may ease the symptoms, but the results will only be temporary. For a long-term fix, you have to manage the underlying medical condition. Try not to experiment with products and home remedies if your acne is PCOS-related. The best option is to consult a dermatologist and have them guide you. Here are some common treatment approaches that a doctor might recommend.

1. Birth control pills

 Oral contraceptives are often the first line of defence against PCOS acne. But not just any birth control pills will do. Doctors usually prescribe a combination pill containing ethinyloestradiol along with progestin norgestimate, drospirenone, or norethindrone acetate. Combination pills contain both oestrogen and progesterone. This mix of ingredients helps maintain the body’s hormonal balance, thereby reducing the oversized impact of high androgen levels.

Don’t expect quick results though. Birth control pills show effectiveness against PCOS acne when used for at least three to six months. So, you will need to be patient.

Also, keep in mind that oral contraceptives are not recommended for women who are older than 35 years or are smokers. Those with a history of blood clots, breast cancer, or hypertension may also have to give this treatment approach a miss.


2. Anti-androgen medication

Androgens are typically considered to be ‘male’ hormones, but women have them too. It is just that androgen counts are naturally lower in women than in men. When PCOS occurs, it puts the natural hormone levels in disarray. Too much testosterone, for example, pushes up sebum production and accelerates skin cell turnover. Excess sebum and dead skin debris end up clogging the pores and causing acne.

Your doctor will run blood tests to see if high androgen counts are driving your acne. If that is the case, then the doctor may prescribe medicines to bring down the level of androgens like testosterone.


3. Retinoids

Retinoids are a handy weapon against wrinkles, but they can also prove useful in beating acne. However, if PCOS is driving your flares, then OTC retinoids will not do the trick. It is best to go with a prescription-strength retinoid recommended by your dermatologist. This is usually either an oral medicine or a topical ointment.

Just remember that retinoid usage requires some precautionary measures. Retinoids increase the skin’s sensitivity to UV rays from the sun. That means you will need to amp up your sun protection. Slather on sunscreen liberally throughout the day—multiple times if necessary.

If your doctor prescribes a topical retinoid, the safest option is to apply it in the evening. This will reduce the risk of sun exposure. As retinoids tend to dry out the skin, the doctor may also recommend using the cream every other day at first. Working your way up to daily usage will allow your skin time to get used to it.


How to treat PCOS acne naturally

Are you looking to treat PCOS acne without birth control and other medication? Lifestyle changes could help with this.

1. Lose some weight: Dropping even a few kilos could reduce your PCOS symptoms and clear up your skin. Take the first steps by adding an exercise routine and watching your diet. Women with PCOS often struggle to lose weight. If that’s you, it may help to consult a fitness trainer and/or a nutritionist. 

2. Watch what you eat: Inflammatory foods like dairy, white bread, and processed foods and drinks are better avoided. Raise your intake of fresh veggies and fruits instead. Add leafy greens, berries, tomatoes, almonds, and fatty fish to your everyday meals. Foods rich in Vitamin C and Vitamin E are especially beneficial for your skin. Also, make sure to drink enough water and head outside each day for your daily dose of Vitamin D. (Discover how gut health affects acne.)

3. Get enough rest: Stress is a regular feature of modern life, but do what you can to get relief from the daily pressures. Commit to a full night’s sleep—anywhere from seven to nine hours is good. Also, make time for meditation and deep-breathing exercises. All of this together will keep your immune system healthy. Besides, you don’t want your stress hormones spiking, as that could increase sebum production and aggravate your acne problem.


PCOS acne skincare routine

Even as you wait for the PCOS treatment to show results, a gentle skincare regimen will do your complexion a world of good. Here are some quick tips:

1. Cleanse away impurities: Wash your face and neck twice daily with a facial cleanser that suits your skin type. This will remove dirt and toxins, as well as prevent any build-up that could clog the pores. If acne is your main concern, look for cleansers containing ingredients like salicylic acid and benzoyl peroxide. Also, make sure to wash off the sweat immediately after exercising.

2. Refresh and deep-clean: After cleansing, refresh your skin with a gentle toner. Toner is great for cleaning out any residual debris from the pores and very effective for oily, acne-prone skin. It also restores the skin’s natural pH level. Take some toner on a cotton ball and swipe all over the face, neck, and chest. Alternatively, you could take a few drops on the palms and press onto the skin.

3. Target acne symptoms: Invest in an acne treatment formula that is gentle on the skin but tough on breakouts. A product like Clearica Anti-Acne Cream, for example, takes a multi-pronged approach. On one side, it fights acne bacteria and limits the spread of infection. On the other, its plant-based formula brings down redness and lesions while soothing irritated and inflamed skin.

4. Moisturise and protect: Never skip moisturiser! A good moisturiser hydrates and nourishes the skin. It also helps lock in the goodness from any serums and treatments you may have applied. It is best to use a moisturiser with a high SPF in the mornings for sun protection. Don’t scrimp on SPF even if it is a cloudy day. If you’ve been prescribed retinoids for your PCOS acne, then all the more reason to apply sunscreen.


What else can you do?

  • Always use non-comedogenic products to prevent blackheads and whiteheads. Look also for products claiming to be non-acnegenic—these will not cause pimples.
  • Exfoliate a couple of times a week to remove build-up and deep-clean pores.
  • Stop yourself from touching the skin all the time. Pricking and squeezing the lesions only delays healing and risks spreading the infection.
  • Practice simple hygiene measures like replacing dirty sheets and towels regularly. Also, make sure to wash makeup brushes and applicators after every use.

(Explore more tips for a spotless complexion!)


Summing up

PCOS acne requires a different plan of action than non-hormonal breakouts. While there are no quick fixes, you can still achieve acne-free skin. The right prescription medicines, a healthy lifestyle, consistent skincare, and a touch of patience are all you need!





Disclaimer: This page is for educational and informational purposes only. It is not intended as a recommendation or for diagnostic purposes. Please consult your dermatologist or doctor before acting on any of the information provided here.