In cases of acne and polycystic ovary syndrome (PCOS), acne can appear on the face, neck, chest, and back. Imbalances of androgens, insulin, and inflammation can cause acne to be deep, cystic, and painful.
Polycystic ovary syndrome (PCOS) is a complex hormonal condition that presents with several hormone symptoms beyond cystic acne. For some women, this means weight gain. For others, it can mean excess hair growth or body hair, hair loss on the head, and irregular menstrual periods. And for as many as 40% of PCOS patients, it means acne.
- Elevated testosterone and other androgen levels behind hormonal acne
- Inflammation, inflammatory lesions (along with the use of an anti-inflammatory diet)
- Bacterial overgrowth
- Elevated insulin
- Excess oil production from the sebaceous glands
- Increased keratin production
Acne and polycystic ovary syndrome are related to what’s happening within your body, which is why a comprehensive approach to address the underlying imbalances happening inside your body, along with solutions for your skin is the best approach.
In this article, I’ll share all you need to know about acne and polycystic ovary syndrome, including its causes, symptoms, and the best treatment of acne prone skin to help you achieve glowing skin again.
In this article
Causes of PCOS acne that we’ll explore in this article:
Comprehensive Guide to Polycystic Ovary Syndrome Acne Treatment
Treating PCOS acne in patients can take a multi-faceted approach, including lifestyle changes, a good skincare routine, and supportive supplements. You want to address your skin on the outside while also working to balance the underlying hormone levels contributing to acne.
I’m going to share a comprehensive guide below. Not all of these options will work for every person, and not every person needs to do all of these things. Finding a plan that works for your body is key, but I want to ensure you know all the options to help you.
- Increasing omega-3 fatty acids, which can help modulate IGF-1 (a hormone associated with acne).
- Improving levels of insulin through physical activity and nutrition to address the androgen production in PCOS ovaries.
- Eating an anti-inflammatory and balanced diet that limits refined sugars and starches to prevent the development of acne.
- Leveraging supplements to support healthy skin with PCOS in mind, such as myo-inositol, probiotics, DIM, and zinc.
- Consider topical treatments like benzoic acid, retinol, and salicylic acid.
- Talk with your doctor about medications like Accutane, Spironolactone, birth control pills (oral contraceptives), or Metformin to be used in addition to the above therapies. Note: These do have side effects and may not always be necessary, which is why talking to a medical provider is important.
PCOS Acne Diet
Nutrients like zinc, vitamin C, and vitamin A are important for the health of your skin. In the case of PCOS-related acne, an emphasis on blood sugar management is important as PCOS is associated with a higher risk of insulin resistance and elevated insulin causes the ovaries to over produce androgens.
Androgens drive the oily skin (sebum production) that can lead to clogged pores and acne. Plus, they are behind what causes facial hair, known as hirsutism. Learn more about what causes hirsutism in women and natural options to address it.
When pores become clogged, bacteria can proliferate, leading to increased inflammation. Many PCOS patients struggle with inflammation, which is why in addition to nutrient density, tailoring the diet to be anti-inflammatory can help manage acne.
An anti-inflammatory diet that emphasizes all the beautiful, essential nutrients for hormone balance and clear skin includes:
- Healthy fats like avocado and omega-3 fatty acids
- High-fiber carbohydrates like whole grains and legumes
- Bright, phytonutrient-rich fruits and vegetables
- Blood sugar-balancing proteins like fish, chicken, or eggs
Limit the ultra-processed foods that don’t provide substantial vitamins or minerals for your body, and instead, aim to fill your plate with the above.
For blood sugar management, include protein, fiber, and fat at each meal to help stabilize your blood sugar.
A tip I share with my patients who want to still consume foods like white potatoes that can spike blood sugar is to allow them to cool in the fridge and eat them the next day. This turns the starches into resistant starches, which are better for you blood sugar and gut.
I know it’s not always easy to get started with diet changes, so I created a free Hormone Balancing recipe guide that includes a 7-day meal plan and recipes to nourish your body and get you started on the path to balanced hormones.
If you think of the food you eat as not just fuel (and not just delicious) but actual information for your body's cells, it makes sense that diet changes can significantly influence skin health and PCOS.
Supplements for PCOS Acne
There are several supplements, including myo-inositol, omega-3 fatty acids, probiotics, and zinc, that have been shown to be beneficial in supporting those with PCOS-related acne.
Myo-Inositol for PCOS Acne
Myo-inositol (commonly referred to as Inositol) is well-evidenced in promoting insulin sensitivity, ovulation, regular menstrual cycles, and fertility. It may also assist the body in balancing androgens.
Inositol has multiple forms, but myo-inositol and d-chiro are the most well-studied for PCOS. Dr. Brighten’s Myo-Inositol Plus was carefully formulated to match the optimal ratio and includes other nutrients that work alongside inositol to support blood sugar balance and hormone production.
Myo-inositol may also aid in weight loss when part of a nutrition and lifestyle plan.
Omega-3 Fatty Acids
Omega-3 fatty acids are anti-inflammatory fats that are found in cold water fish and certain seeds, like walnuts. They have been shown to be beneficial to skin health and assist in clearing acne.
In one small randomized control trial1 it was found that daily supplementation with 2,000 mg of omega-3’s significantly reduced acne after 10 weeks. The duration of time is important to note because this is an intervention that you will have to be consistent with over a period of time.
While more research is needed to assess the use of omega-3 fatty acids as a standalone treatment for acne, the current studies suggest it is a helpful adjunct therapy.
Focusing on dietary omega-3 fatty acids and adding in a high quality omega-3 supplement may be the best approach.
Saw Palmetto for PCOS Acne
In cases where dihydrotestosterone (DHT) is driving acne, saw palmetto may help support your body in balancing this androgen. Saw palmetto can help optimize 5-alpha reductase, an enzyme that converts testosterone into DHT, a potent androgen to help lessen the DHT effect.
You can check out my Saw Palmetto Plus that helps support balancing the hormones behind acne in PCOS.
Women’s Probiotic for PCOS Acne
Acne is a condition that is linked to the health of the gut and microbiome, the organisms that inhabit your intestines. Studies2 have stated, research shows that the use of probiotics may reduce skin eruptions”.
There’s a strong connection between the health of your microbiome, PCOS, and hormone balance. A quality probiotic can support gut health and hormone balance.
I created one of my recent products, Women’s Probiotic, to provide a probiotic specifically formulated to support gut, vaginal, and urinary tract health.
Supplements for PCOS acne can provide an extra layer of deep support.
Stress Management Techniques for PCOS Acne
What do exercise and stress have to do with your skin? A lot, especially for people with PCOS. Stress hormones like cortisol directly impact hormone balance and can even increase androgen production3. In some cases of PCOS, known as adrenal PCOS, the adrenal glands produce DHEA, which is an androgen that can drive symptoms.
Becoming more stress-resilient gives your body the space to breathe when you’re completely overwhelmed by life.
A few ideas to reduce stress include:
- breathing exercises
- apps for guided meditations
- Yoga
- Walking
For a comprehensive list of stress reduction practices, visit this article.
Exercise for PCOS Acne
Movement also helps the cells in your body become more insulin-sensitive4, which is an important step in reducing androgen production.
If you’re looking for a place to start with exercise, strength training will give the greatest benefits in the shortest amount of time.
Related: How to exercise with your cycle.
Topical Treatment for PCOS Acne
Topical antibiotics, retinoids, salicylic acid, and some natural ingredients can help manage PCOS acne.
Acne vulgaris, the medical term for black heads, pimples, and pustules, usually responds well to a combination of lifestyle and medication therapies. In cases of persistent adult acne, medication may be used as first line to reduce acne flare-ups while nutrition and lifestyle therapies are incorporated by the patient.
Understanding Topical Retinoids
Retinoids5 are a common treatment for acne because they help resurface and bring up new, healthy skin cells while reducing inflammation. They are a derivative of Vitamin A and can be particularly helpful in treating PCOS acne since they work to unclog pores, control oil production, and reduce inflammation.
Retinoids can take time to work, but they can help improve your skin's overall appearance and texture. You can find many over-the-counter retinol products that are a bit milder, but prescription-strength retinoids will generally be more effective.
Retinoids can irritate your skin in the beginning, so follow your dermatologist's advice or start with a few times a week with breaks between so you don’t damage your skin barrier.
There is also no evidence on pregnancy safety, therefore, it’s advised you avoid use while pregnant.
Benefits of Benzoyl Peroxide
Benzoyl peroxide6 is a common ingredient in many acne treatments that kills bacteria contributing to inflammation and breakouts. Additionally, it can help unclog pores and reduce excess oil production. Treatments range from lower percentage concentrations that can be found over the counter to higher strengths that require a prescription.
You can find it in creams, face wash, or gel.
Unfortunately, benzoyl peroxide can dry and irritate, so using a moisturizer with any benzoyl peroxide treatment is important. Start with a lower strength and gradually work your way up if needed, as using too high of a concentration can cause redness and more irritation.
Natural Topical Treatments
Other natural topical treatment options include tea tree oil, witch hazel, and green tea extract. These ingredients have anti-inflammatory and antibacterial properties that can help reduce the appearance of acne.
There isn't a lot of research on the effectiveness of these treatments specifically for PCOS acne, but they can be a gentler option for those with sensitive skin.
Salicylic Acid
A popular exfoliating acid, salicylic acid helps unclog pores and reduces oil production, which may help prevent future outbreaks.
Topical Antibiotics
These can address the bacteria that are behind the acne cysts and pimples.
Two of the most common used topical antibiotics for polycystic ovarian syndrome acne treatment are:
- Erythromycin
- Clindamycin
These are available as solutions, lotions, gels, and saturated pads.
They do disrupt the skin microbiome, which is why we want to use the lowest, most effective dose for the shortest period of time.
Oral Medication for PCOS Acne
Among the top oral medications for PCOS acne are oral retinoids, hormonal birth control, and androgen reducing drugs, like Spironolactone.
I have many patients who opt to go all natural in their approach and others who use a medication alongside nutrition and lifestyle therapies. Then, with the proper natural and lifestyle habits, medications can be weaned down or removed altogether.
The best way to approach acne is the way that works for you.
Accutane
This is an oral retinoid, which can be quite effective for acne, but can come with side effects like headaches, dry skin and eyes, as well as rashes. Like topical retinoids, you need to be using sunscreen daily because it can increase your sensitivity to the sun, including sun burns.
You cannot get pregnant while on this medication, which is why oral contraceptive pills or IUDs are generally recommended along with it. See the contraception guide for pregnancy prevention options.
Hormonal Birth Control
This is a common prescription for those with PCOS because of its ability to reduce androgen production and induce a withdrawal bleed that allows the endometrium to be removed from the uterus.
While it can be incredibly effective for some, the pill doesn’t work for all (and can even cause acne in some cases).
The problem with using birth control without addressing what’s happening in the body is that once you stop taking the pill, the symptoms come roaring back. And in addition, it doesn’t address the insulin resistance, inflammation, or gut issues associated with PCOS.
If you opt to use the pill, I recommend also incorporating nutrition and lifestyle therapies so you can address the other health issues associated with PCOS.
Anti-Androgen Medications
Androgen- lowering medications is a hormonal therapy that may help by regulating the hormones that cause PCOS acne. Spironolactone, for example, is a popular anti-androgen medication that can help regulate testosterone levels and reduce acne.
These medications can also address excessive hair growth.
It should be noted, however, that these medications come with potential side effects, so you should weigh the pros and cons with your doctor.
Insulin-Sensitizing Drugs
In some cases, drugs like metformin help regulate insulin levels and improve symptoms of PCOS, including acne. These drugs help the body better utilize insulin. They aren't necessarily used to treat acne but symptoms of PCOS overall.
Medications that address insulin sensitization can also aid in weight loss.
Oral Antibiotics for Polycystic Ovarian Syndrome Acne Treatment
Oral antibiotics must be taken for a minimum of 6-8 weeks to evaluate how effective they are. Because of their wide reaching system effects, disruption of the microbiome, as well as side effects, these are reserved for when topical antibiotics have failed, as is the case in persistent acne.
Common oral antibiotics for PCOS acne include:
- Doxycycline: Used for moderate to severe acne vulgaris. Photosensitivity (sunlight sensitivity) is a common side effect.
- Tetracycline: This drug can cause severe phototoxicity, gastrointestinal issues, and disrupt fetal development. The latter is why it should not be used when pregnant.
- Erythromycin: Now considered a second-line therapy if other antibiotics because antibiotic resistance to this drug is common.
- Minocycline: This antibiotic is reserved as a “last resort” treatment due to the potential for serious side effects.
Advanced Therapies for Severe PCOS Acne
Sometimes, people choose to have chemical peels, laser therapy, or photodynamic therapy to address severe acne, hyperpigmentation, or acne scars. I recommend you seek the advice of a trusted dermatologist for more information about whether these treatments are right for you.
PCOS and Hormonal Acne
Studies estimate that 30 to 40 percent of women with PCOS also struggle with acne. The causes of acne7 are multifactorial but generally stem from excess oil production, bacterial imbalances, clogged skin cells or hair follicles, and inflammation.
Hormones can influence all of these, which is why this is considered a form of hormonal acne.
Women with PCOS may experience breakouts on their face, chest, or back and experience more severe forms of acne.
Causes of Acne in Women with PCOS
Acne can have several causes, but the primary reason in this case is the metabolic and hormonal imbalances associated with PCOS.
The Role of Androgens in Acne and Polycystic Ovary Syndrome
Most women with PCOS have elevated levels of androgens8 in their bodies. Many think of androgens as “male” sex hormones like testosterone, but they also exist in women’s bodies. In PCOS, androgens are often higher than they should be, throwing off overall hormone balance.
High androgens are behind many of the symptoms of PCOS, including acne. In the skin, androgens may alter sebum production – the waxy, oily substance that can combine with dead skin cells and bacteria to clog pores and cause acne.
Insulin Resistance and Inflammation
In addition to excessive androgens, around 35 and 80 percent9 of women with PCOS have insulin resistance. Insulin is a hormone that helps regulate your blood sugar levels. When your blood sugar rises after meals, insulin helps direct the sugar out of your blood (called glucose) and into the cells for energy.
With insulin resistance, the cells ignore the insulin signals, so the body keeps releasing more insulin to try and compensate. Eventually, higher-than-normal insulin levels can contribute to metabolic dysfunction and inflammation in the body, contributing to acne.
Studies10 suggest that high insulin levels can increase the production of androgens from the ovaries, further exacerbating the hormonal imbalances behind PCOS acne. We also know that insulin resistance and inflammation are linked as one condition can contribute to another. Insulin resistance causes inflammation, but inflammation can worsen insulin resistance, creating a vicious cycle.
What Else Causes Acne
PCOS isn’t the only cause of acne, although hormone imbalances are a significant factor. Other causes of acne include:
- Estrogen dominance
- Bacteria
- Stress
- Medication
- Other hormonal influences like perimenopause or pregnancy
- Lack of a skincare routine (like going to bed with makeup on)
- Harsh skincare products
Symptoms and Diagnosis of PCOS Acne
The symptoms and diagnosis of PCOS acne depend on the individual. For people who have already been diagnosed with PCOS, a diagnosis of PCOS acne is relatively straightforward. Since it’s estimated11 that up to 75% of people live with undiagnosed PCOS (or take a long time to get the appropriate care), understanding how to recognize acne related to PCOS can be incredibly helpful to get on the right path to treatment.
Recognizing Symptoms of PCOS Acne
I often see PCOS acne as cystic, painful bumps under the skin. It tends to be more challenging to treat and may extend to other parts of the body, as I mentioned above, like the chest and back.
Other PCOS symptoms, including irregular periods, hirsutism, or thinning hair, may accompany PCOS acne. These are all signs of excess androgens, which can contribute to acne development.
Steps to Diagnose PCOS Acne
The first step to diagnosing PCOS acne is getting the proper PCOS diagnosis. If you’ve already been diagnosed with PCOS, you can work with your healthcare practitioner to address the acne, but if you’re unsure whether you have PCOS, then seeking a diagnosis is vital.
- Track your cycles. If they are irregular or your period comes more than every 35 days, this is important to convey to your provider.
- Meet with a licensed healthcare provider for a thorough medical history. PCOS is a diagnosis of exclusion, meaning other issues need to be ruled out.
- Have appropriate lab testing like androgen levels, fasting insulin, fasting glucose, HgA1C, and others.
- Consider whether a trans-vaginal ultrasound is right for you. This isn’t necessary to diagnose PCOS, but it can provide useful information in some cases.
Once you have a confirmed PCOS diagnosis, your healthcare practitioner may refer you to a dermatologist for more supportive skincare guidance and discuss other treatment options.
Conclusion: Dealing with PCOS Acne
Dealing with PCOS acne can be quite a rollercoaster ride. It's not just about the physical discomfort or how it affects your appearance; the psychological toll can be equally, if not more, challenging.
But here's the thing: you can find the proper treatment approach by understanding PCOS acne and all your options. Be patient with your body, reach out to healthcare professionals as needed, and most importantly, be kind and compassionate to yourself throughout this journey. Looking for a holistic solution for your PCOS acne? Explore our range of products tailored for PCOS skin health.
References
- https://pubmed.ncbi.nlm.nih.gov/24553997/ ↩︎
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8953587 ↩︎
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9705998/ ↩︎
- https://bmjopensem.bmj.com/content/2/1/e000143 ↩︎
- https://www.jaad.org/article/S0190-9622(15)02614-6/fulltext ↩︎
- https://www.jaad.org/article/S0190-9622(15)02614-6/fulltext ↩︎
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8826298/ ↩︎
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7882969/ ↩︎
- https://www.wjgnet.com/1948-9358/full/v13/i3/129.htm ↩︎
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8107978/ ↩︎
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6266413/ ↩︎
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