Acne and PCOS

If you have PCOS, then you likely know that pimples aren’t just for teens. But you’re not a teenager anymore, so why are you more likely to have excessive acne just because you have polycystic ovarian syndrome? Unfortunately, the reason for your acne is also likely the reason why conventional acne treatments aren’t as effective for you.

What is Acne?

Acne occurs when oil, bacteria, and skin cells get trapped in our skin’s pores. In women with PCOS, androgen levels are often elevated. As a result, your production of dihydrotestosterone, a metobalite of testosterone, rises. Dihydrotestosterone (DHT) promotes oil production, which can lead to your pores getting clogged. Once clogged, bacteria can flourish, but also get trapped along with excess oil and dead skin cells, resulting in inflammation, or a "pimple". Although acne usually occurs on the face, it is not uncommon for it to also appear on the neck, chest and back. For women with PCOS, acne often appears along the jaw-line as well as the chest and back.

While acne is used to refer to a number of skin inflammations, there are actually different types of pimples. These include:


  • Blackheads: This type of acne results when oil and bacteria rise to the top of pores that are partially blocked. Once the oil mixes with both your skin melanin and air, the pimple takes on a darker appearance, making it look "black," hence the name blackhead.
  • Whiteheads: A whitehead is the result of oil and skin cells completely blocking your pores. This debris gathers beneath the surface of your skin, resulting in a pimple that appears to have a white head.
  • Cysts: This type of acne can be quite unpleasant and even painful and may cause cystic acne pimples that are five millimetres or more in diameter. They occur when oil, dead skin cells, and bacteria are pushed far down into your pores leading to hard bumps that you can feel underneath your skin and that may swell and remain for months.
  • Pustules: Similar to whiteheads in formation, pustules differ by being much more painful and inflamed. Typically, a pustule will look as though it has a white or yellow head surrounded by a red circle.


Severe acne can lead to permanent acne scars as well as discoloration of the skin.


What Causes Acne

Normally, there are a variety of reasons why an individual may suffer from acne. Things like stress, medications, cosmetics, over-washing your face, an allergic reaction or being exposed to industrial pollutants have all been linked to causing acne. However, for women with PCOS, while these reasons may also be behind your acne, it is generally acknowledged that hormones and insulin resistance are the more likely culprits.

Because women with PCOS usually have elevated androgen levels, their production of DHT is increased and this in turn leads to acne. It is also common for women with polycystic ovary syndrome to be insulin resistant. And insulin resistance not only prevents you from ovulating, but also increases your androgen levels, again elevating your DHT levels, thereby inducing acne.


Treating Acne

There are many different types of acne products available over-the-counter or by prescription. While these can be helpful to reduce the appearance of your acne, they will not permanently get rid of your acne. Because elevated androgen levels are the culprit behind acne in women with PCOS, it is necessary to treat this problem in order to see a more long term acne solution.

Two of the most common ways acne is treated in women with PCOS symptoms is through the use of spironolactone (sold under the name of Aldactone) and birth control pills. Both types of medications require a prescription. Although spironolactone is actually a blood pressure medication, it has been found to be effective at reducing the appearance of acne either on its own or in combination with oral contraceptives. Spironolactone is designed to block aldosterone hormones, which raise your blood pressure. However, aldosterone is chemically similar to testosterone, therefore spironolactone is also able to block testosterone. This lowers your androgen levels and helps relieve acne symptoms.

Similarly, the birth control pill also helps to lower your levels of testosterone thereby improving the appearance of acne. If oral contraceptives are not enough to improve your acne, though, using them in combination with an acne medication or incorporating some acne skin care steps into your daily regime may help.

If you have an insulin resistance problem, it is likely that you will be prescribed Metformin. This medication can also help with acne treatment as it regulates your insulin levels, which will help to normalize your hormones and lower your androgen levels. However, metformin as well as birth control pills, spironolactone and other acne medicines, do have side effects. If you are considering taking a medication, it is important to discuss all the possible side effects with your doctor first. Also, keep in mind that all medications will work differently in each woman. Some women may find that a particular drug is very helpful while another may find that it does nothing or even worsens their symptoms. You may need to try a few different treatments for acne before you find the one that is right for you.

Click here for more information on acne treatment.


Acne and Your Diet

Often, people think that acne is caused by their diet. If they eat too much greasy, unhealthy food, they’re more likely to have pimples. While it’s untrue that oily foods will cause acne, there is some truth to the belief that your acne woes are related to your diet.

Both dairy products and refined carbohydrates have been shown to affect acne, particularly in those with PCOS. Because they are processed, refined carbohydrates have a high glycemic index and produce a lot more sugar in your body. This causes your body to create more insulin, which increases your androgen levels, contributing to sebum (oil) production leading to acne.

With dairy, the problem seems to lie in the fact that cow’s milk contains various hormones that can be broken down into DHT. Pregnant cows in particular produce large amounts of these hormones. Unfortunately, as much as 90% of the milk market may be made up of milk from pregnant cows. People that drink a lot of milk will be getting extra doses of DHT. Plus, consuming large quantities of milk has been shown to increase insulin-like growth factor 1, which also contributes to acne. However, the good news is that not all dairy products have been found to be problematic. Those that do seem to contribute acne include cottage and cream cheese, breakfast drinks and sherbet while items like pizza and chocolate don’t seem to affect acne at all.

Reducing the amount of dairy you consume may help ease some of your acne symptoms. Additionally, following a low-glycemic index diet may help lower your insulin levels thereby helping to get rid of pimples.


Natural Ways to Get Rid of Acne

Whether you are taking acne medications or not, there are a number of home remedies for acne that you can try.


  • Wash your face twice daily. Be careful not to over wash your face, though, as this can cause more acne flare-ups.
  • Use hypoallergenic products and mild soaps whenever possible. For proper natural acne skin care, it is important to use products that are not irritating to the skin.
  • Clean your bedsheets, especially your pillowcase, weekly with mild, chemical-free detergent.
  • Avoid foods that are high in sugar or fried, are processed (particularly carbohydrates), contain trans fatty acids, or are made with partially hydrogenated oils


There are also a number of supplements you may want to take, including zinc and saw palmetto (both of which are known to help reduce testosterone levels); vitamin B6; vitamin E; essential fatty acids; pantothenic acid; and selenium. However, be sure to discuss your needs with a trained naturopath. She can recommend the appropriate combination of supplements for you based on your needs and the current medications you are taking.

Another popular home remedy for acne is the use of topical tea tree oil. Although tea tree oil takes longer to be effective, many people prefer it over benzoyl peroxide because it has fewer side effects. Azelaic acid can also be used as a topical acne treatment.

Acne can be difficult to deal with.  Turn to our Healthy Skin Portal for research into procedures such as microdermabrasion.  A microderm can really help you get the skin you have always wanted.  It can even help with acne.

If you are looking for suggestions for acne treatment from a professional dermatologist then click here.


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