What to Know About PCOS Acne

Polycystic ovary syndrome (PCOS) is a disorder that causes the ovaries to overproduce androgens, a group of hormones present in larger amounts in people with testes and smaller amounts in people with ovaries.

The main androgen hormones are testosterone and androstenedione. High androgen levels can lead to several symptoms, including acne.

Read on to learn more about how PCOS can affect acne and what you can do about it.

Hormonal Acne From PCOS

Everyone produces androgens in varying amounts based on whether they have ovaries or testes. In people with ovaries, androgens are produced in the ovaries, adrenal glands, and fat cells. In normal amounts, these hormones serve a healthy purpose. If an overproduction occurs, symptoms can arise such as:

• Excess facial or body hair
• Acne and/or oily skin
• Thinning hair on the head
• Insulin resistance (poor response to insulin results in high blood sugar levels)
• Acanthosis nigricans (rough, darkly pigmented areas of skin)
• Increased fat, particularly around the mid-abdomen
• Irregular or absent menstrual cycles

Excess androgen is a hallmark symptom of PCOS (a symptom that is typically present).

Appearance and Location

PCOS acne tends to have lesions that are larger, deeper, and/or resolve more slowly than other forms of acne.

It can occur anywhere, but PCOS acne usually appears on the lower face, such as:

• Jawline
• Chin
• Upper neck

What Causes PCOS Acne Flare-Ups?

Excess testosterone stimulates oil glands and hair follicles, which can cause acne to develop. People with PCOS may also find their acne becomes worse around the time when they are menstruating.

Non-PCOS Causes of Acne

The presence of acne is not enough of its own to make a diagnosis of PCOS.

Other causes of acne include:

• Fluctuating hormone levels: These may occur around menstruation or during pregnancy, perimenopause, and menopause, and when starting or stopping hormonal birth control.
• Stress: Bodies can produce more androgens in response to stress.
• Family history: Research suggests acne may have a genetic component. PCOS may also be hereditary.
• Product use: Some hair and skin products can clog pores, contain oil, or irritate the skin.
• Side effects of medication: Acne is a possible side effect of some medications,
• A medical condition: Acne can result from a medical condition, including PCOS and others. Treating the condition often improves the acne.

Tests to Diagnose PCOS

A physical exam and a discussion of symptoms, family history, and medical history are the primary ways PCOS is diagnosed.

A healthcare provider may also order tests to confirm a diagnosis of PCOS and look for other possible causes for the symptoms.

Blood Tests

Blood tests are run to check hormone levels, such as excess androgen. At the time of diagnosis and often regularly once diagnosed, blood tests may be ordered to check blood glucose levels, cholesterol, and triglyceride levels as people with PCOS are at an increased risk of insulin resistance, high blood pressure, and high cholesterol.

Ultrasound

Some people with PCOS have multiple ovarian cysts, which can cause enlarged ovaries. An ultrasound uses sound waves to create computer-generated images that are used to check the size of the ovaries, the presence of cysts, the thickness of the uterine lining, and other related observations.

PCOS Acne Treatment

Treating PCOS-related acne usually involves addressing hormonal imbalances and taking other measures to manage PCOS. Other acne-specific treatments may also be recommended.

Medication

Oral Contraceptive Pills (OCP)

OCP is a common first-line treatment for people with PCOS who do not currently wish to become pregnant. The type of pill matters. The combination pill (estrogen and progestin) should be used instead of the minipill, which contains only progestin.

Some progestins can mimic androgens and worsen symptoms, but others allow the estrogen to reduce the symptoms associated with excess androgen. Ask your healthcare provider about which formulations best address your symptoms and needs. There are people who should not take OCP due to their medical history.

Antiandrogens

Antiandrogens can target symptoms such as acne and excess hair growth associated with high androgen levels. Aldactone or Spironol (spironolactone) is most commonly prescribed, often with OCP.

Do not take spironolactone if you are pregnant or may become pregnant, as it can cause harm to an unborn baby. If taking this medication, contraception needs to be used to prevent pregnancy.

Acne Medications

Medications typically used for acne may be helpful for people with PCOS, particularly in combination with PCOS treatments.

They can include:

• Benzoyl peroxide: Found in products such as Clearasil, Stridex, and PanOxyl, it targets surface bacteria.
• Salicylic acid: In products used as a cleanser or lotion, it dissolves dead skin cells to stop hair follicles from clogging.
• Azelaic acid: This natural acid, found in grains such as barley, wheat, and rye, kills microorganisms on the skin and reduces swelling.
• Retinoids: Vitamin A derivatives such as Retin-A, Tazorac, and Differin break up blackheads and whiteheads and help prevent clogged pores. Do not use if pregnant or if you may become pregnant. Retinoids have specific instructions for use and can have side effects. Use under the guidance of a healthcare provider or pharmacist.
• Topical antibiotics: These include Clinda-Derm (clindamycin) and Emcin (erythromycin). They control surface bacteria and are more effective when combined with benzoyl peroxide.
• Aczone (dapsone): This topical gel has antibacterial properties. It is applied to the skin twice a day.
  

Lifestyle Changes

PCOS can cause weight gain and make it harder to lose weight. High body fat can also make PCOS symptoms worse.

People with PCOS who have high body fat may reduce PCOS symptoms by practicing healthy eating, getting plenty of exercise, and, in many cases, losing weight. A weight reduction of 5% can improve problems such as insulin resistance high levels of androgens in people with PCOS.

Anti-Inflammatory Diet and Supplements

People with PCOS often have chronic low-grade inflammation. Inflammation can also occur with acne.

While not a treatment for PCOS or acne on its own, eating foods that reduce inflammation may be beneficial. These include:

• Vitamin A: Sweet potato, spinach, carrots, and tomatoes
• Vitamin C: Citrus, cantaloupe, and red and green peppers
• Vitamin D: Oily fish, fortified foods, and dairy products.
• Calcium: Low-fat milk, cheese, broccoli, kale, fortified orange juice, low-fat Greek yogurt, and fortified nondairy milk
• Copper: Sesame, pumpkin, shiitake mushrooms, pumpkin and sunflower seeds, and cashews
• Zinc: Lean beef, crab meat, chicken, cashews, and fortified cereals
• Turmeric: Found in curry powder; can add to food or take 400 milligrams daily in supplement form
• Garlic: Plant from the onion family; can cook with two to four garlic cloves daily
• Bromelain: An enzyme found in pineapple juice

Daily PCOS Acne Care

 In addition to treatments:

• Wash your face twice daily using warm water and a mild facial cleanser.
• Use moisturizer regularly.
• Choose makeup and skin-care products that are gentle and specially designed to not block pores.
• Remove makeup at the end of each day.
• Avoid touching your face.
• Stay out of the sun and tanning beds, especially if using certain medications that make you more sensitive to ultraviolet (UV) rays.

Summary

The elevated androgen hormones associated with PCOS can cause or worsen acne. Treating the hormonal imbalance can improve PCOS symptoms, including acne. Treatments can include medication, lifestyle habits, and skin care routine.

A Word From Verywell

If acne from PCOS is causing you distress or discomfort, see your healthcare provider. A medical professional can help you manage the underlying condition and treat the acne specifically.