Does PCOS Cause Acne? Treatment Options and More

• Polycystic ovary syndrome is a condition that causes the ovaries to overproduce androgens, male sex hormones
• This imbalance can cause ovarian cysts, irregular menstrual periods, weight gain, oily skin and acne
• Treatment focuses on management of symptoms, as PCOS is a lifelong condition and  cannot be cured

Polycystic ovary syndrome (PCOS) is the most common hormonal disorder among US women of productive age, affecting 5%–10% of this group. It can cause a number of issues to develop such as weight gain and excess hair growth or thinning hair. PCOS acne is another common side effect, and occurs due to the sebum-stimulating activity caused by excess androgen hormones.   

What Is PCOS?

PCOS is caused by an imbalance in hormones, and is referred to as a syndrome because it produces a range of specific symptoms, demonstrating it has a far-reaching effect: 

• Acne, sometimes severe
• Alopecia (hair loss)
• Hirsutism (excess facial and body hair)
• Hyperpigmentation
• Infertility
• Irregular, very light or missed periods
• Oily skin
• Weight gain

The ovaries are responsible for producing and secreting an important groups of sex hormones called progesterone and estrogen which are necessary for the ovaries to stimulate the release of eggs. These hormones are triggered by the pituitary gland when it releases luteinizing hormones and follicle-stimulating hormones.

With PCOS, ovaries overproduce androgens which causes an imbalance in reproductive hormones. Androgens are male hormones that are present in both men and women. However, elevated levels in women cause male characteristics to develop as well as a host of unwanted side effects.

Elevated levels of androgens interfere with and make it more difficult for ovaries to release mature eggs. Women with this syndrome may not be able to ovulate; instead eggs stay within the ovaries surrounded by pockets of fluid called cysts. They do not cause discomfort or pain.   

Women with PCOS are at higher risk of developing serious health conditions, notably type 2 diabetes, cardiovascular disease, endometrial, breast and ovarian cancer.

There is no one cause of PCOS but science theorizes that insulin resistance is a key factor as too much insulin stimulates androgen production. There is also evidence to suggest genetic, environmental, occupational and lifestyle influences can all play a role in PCOS development. 

Does PCOS Cause Acne? 

Yes, PCOS can cause mild-to-severe noninflammatory or inflammatory acne. 

Acne develops when sebum (an oily substance secreted by sebaceous glands) dead skin cells and debris accumulate within pores to form comedones (whiteheads and blackheads). If left untreated, Cutibacterium acnes bacteria can multiply, which increases inflammation and the formation of more severe acne such as cystic acne.

In the case of PCOS, a dysregulation of hormones causes greater sebum production which encourages the formation of acne lesions.

PCOS and hormonal acne

PCOS is a form of hormonal acne.

During specific life events such as puberty, pregnancy and menopause, and with conditions such as PCOS, fluctuations in hormones cause a spike in sebum production and have a direct influence in acne inflammation. 

Hormonal acne develops when pores become clogged with oils, debris and bacteria – just like any other acne. As with PCOS, what drives this development is fluctuations in androgen hormones which boosts sebum production.

This link is evident, as many women with PCOS have acne lesions on their face and up to 50% have lesions on their neck, chest and upper back.

Hormonal acne tends to develop on the lower part of the face; along the jawline, cheeks and chin. Symptoms can range from mild comedones to inflamed papules, cysts and nodules and tend to flare up before the menstrual cycle. 

PCOS and acne scars

PCOS can cause inflammatory acne which is characterized by inflamed pus-filled lesions; when symptoms are severe, cysts and hard nodules can form deep within skin tissue which can cause hyperpigmentation and scars, some disfiguring. 

Acne scars can be hypertrophic (raised) or atrophic (indented). Atrophic acne scars are the most common type and are a result of disorganized production and deposition of collagen during the healing process. 

Is PCOS Causing Your Acne?

If your menstrual cycle is irregular and you’re noticing excess facial and body hair, or thinning hair on your scalp, you should see your doctor who may refer you to an endocrinologist to determine if you have PCOS. 

The Rotterdam criteria is used for diagnosing PCOS. This is defined as the presence of two of the following criteria: excess androgen, ovarian dysfunction or polycystic ovaries.

Your care provider will likely order blood work, and perform a pelvic exam and ultrasound to determine if  PCOS is the cause of your acne. Once you have been examined and diagnosed, you can start treating the symptoms and the cause – whether the acne is PCOS-related or not. 

How to Treat PCOS Acne

PCOS acne treatment takes an individualized approach to target specific concerns such as infertility, obesity and acne. As such, it involves a number of systemic medications and supplements to regulate hormones, encourage ovulation and heal acne lesions.  

Once diagnosed with PCOS, you can discuss your concerns and symptoms with your care provider and discuss a course of action.

Birth control 

The synthetic hormones found in combined (estrogen and progestin) oral contraceptive pills (cOCPs) can regulate the menstrual cycle and balance androgen levels, which in turn reduces sebum production and calms acne. This is considered a first-line treatment for women with PCOS who are not looking to treat infertility.  

A recent study review of 81 clinical trials found that cOCPs reduced both inflammatory and noninflammatory lesion counts and decreased acne severity grades; total acne lesion counts decreased by 40%–60%.

Oral contraceptives are not appropriate for every woman who has PCOS as there is an increased risk of venous thromboembolism, heart disease such as hypertension and metabolic disorders such as diabetes. 

Supplements

Vitex agnus-castus, also known as vitex or chasteberry, is a dietary supplement that can be found in liquid or powder form in health food stores. 

There is evidence to support that with continued use, vitex can regulate menstrual cycles and improve fertility, and can do so with notably fewer side effects than oral contraceptives.

N-acetyl-cysteine (NAC) is a modified amino acid that is a powerful antioxidant and necessary for overall health. It has been studied in combination with the drug metformin which is commonly used to treat type 2 diabetes and PCOS as both conditions are related to insulin resistance.

In one comparative study, NAC and metformin both reduced BMI, hirsutism, blood sugar levels, and menstrual irregularities. Both led to a significant decrease in total cholesterol, but NAC had the added benefit of decreasing low-density lipoprotein levels, lowering the risk of heart disease and stroke. 

Zinc is a trace mineral that can help heal acne as it is an anti-inflammatory, can regulate sebum production and contributes to every facet of the wound healing process.

Women with PCOS tend to have low zinc levels which has a direct impact on the reproductive system. In one comparative study review examining women and the reproductive system, researchers found that zinc supplementation had a positive effect on many factors, especially on insulin resistance and as an anti-androgen. In addition, it has been shown to provide beneficial effects on alopecia and hirsutism.

These supplements work in different ways to balance the reproductive system which lowers sebum production to improve acne symptoms and reduce future outbreaks.  

Topical retinoids

Retinoids can be very effective against PCOS acne as they deeply exfoliate to unclog and maintain clear pores by promoting skin cell turnover. Other benefits include reduced hyperpigmentation and increased collagen production for thicker, healthier skin.   

Retinoids are typically prescribed in conjunction with oral contraceptives to manage symptoms of the primary condition, PCOS, when appropriate.

Skin Care Routine for PCOS Acne 

If left untreated, mild acne lesions can degrade, become inflamed and result in widespread lesions and possible scarring. It is therefore important to follow a carefully planned skin care routine to manage symptoms.  

Morning routine

Your morning routine can focus on gently cleansing your skin and protecting it with a skin-boosting moisturizer and sunscreen.

1. Gently wash your face with a low pH cleanser containing niacinamide. Its anti-inflammatory benefits can reduce swelling and redness associated with inflamed lesions plus it can regulate oil production. 

2. Follow with a toner to remove any lingering residue and to prepare your skin for better absorption of any other topical you apply. Glycolic acid is an ideal choice for oily skin while dry or sensitive skin would be best served by lactic acid’s gentleness. 

3. Depending on your level of acne, apply benzoyl peroxide with a cotton ball as a spot treatment or over your entire face, avoiding the eye area.  Benzoyl peroxide is prized for its ability to exfoliate, dry up excess oils, reduce inflammation and kill C acnes. 

4. Follow with a noncomedogenic moisturizer that is formulated with ceramides, amino acids and glycerin. These work to maintain a healthy skin barrier by hydrating and protecting from moisture loss to keep skin supple, comfortable and healthy. 

5. Apply a sunscreen of at least SPF 30 if going outdoors. You will be protecting your skin from harmful UV rays but also against exposure to free radicals – which can increase inflammation and worsen acne.

Evening routine

The evening is an ideal to include more intensive agents to support your skin’s restoration process while you sleep.

1. In place of your regular cleanser, wash your face with an exfoliant (twice weekly to avoid overdrying skin) such as one containing salicylic acid to clear away the sunscreen along with grime, oils and dead skin cells. This agent is an ideal choice for acne-prone skin as its exfoliating powers can break down and slough off comedones and pimples. (This also prevents more severe acne lesions from forming.)

2. Follow with a glycolic acid or lactic acid toner, based on your skin type.

3. Apply a pea-sized amount of retinoid cream to your entire face, avoiding the eye area. This will clear pores of dead skin cells and debris as well as improve texture and tone. 

(To avoid irritating your skin, use 2–3 times a week and work up from there.)

4. Opt for a moisturizer that is labeled as a night cream; these are typically infused with agents that can boost the quality of your skin during night time repair. Look for hyaluronic acid, which delivers deep hydration and moisture retention; niacinamide to address sensitivity and redness; and peptides which help heal acne and contribute to skin’s firmness and elasticity. 

If at any time during your routine you notice that your skin feels tight, red or irritated, reduce the frequency of the salicylic acid, benzoyl peroxide or retinoids or eliminate use of one product altogether, as this combination can be too harsh for some skin types.  

Takeaway

Polycystic ovary syndrome (PCOS) is the most common hormonal disorder among US women of productive age. It can cause a number of unwanted and sometimes serious effects to occur including alopecia, hirsutism, infertility, weight gain and acne. 

Acne can present as mild to moderate and fall within the category of  inflammatory or noninflammatory. While PCOS is not curable, its symptoms can be successfully managed through a multimodal approach that combines system and topical therapies. 

Acne is a common symptom of PCOS because the hormonal imbalance triggers excessive sebum production which combines with debris and dead skin cells to block pores. Sebum levels can be regulated by taking combined oral contraceptives and certain supplements.

The symptoms of acne can be treated and prevented by consistently following a good skin care routine that includes an effective cleanser and exfoliant to clear pores and prevent lesions from forming. Include a quality moisturizer that includes moisturizing agents to protect skin and maintain the integrity of the skin barrier.