- Best Results3-6 months
- Treatment RecoveryNA
- Procedure TimeNA
- Skin SpecialistDermatologist
- Duration of ResultsVariable - years
- AnaestheticNA
- Back to WorkNA
- Cost$
PCOS Acne
PCOS is one of the most common causes of acne. In Australia 10-15% of women have PCOS. This form of acne is frequently referred to as hormonal acne. It can be persistent & resistant to conventional treatments. A simple guide is outlined below. A dermatologist can effectively manage PCOS & hormone associated acne.
FactsFacts On PCOS Acne
- PCOS is the most common syndrome associated with acne
- Oil glands produce more sebum, in response to over activation due to hormones
- An anti-acne diet is useful in some
- BHA washes & retinol can reduce acne outbreaks
- Hormonal modulation & regulation gives a predictable reduction in acne counts
- A dermatologist can make a significant impact on acne associated PCOS
Why does acne occur in PCOS?
PCOS, by definition is due to androgen excess & or sensitivity. Androgens are hormones secreted by the adrenal glands & ovaries that stimulate the production of sebum or oil. This leads to hormonal acne.
What treatments are there for acne due to PCOS?
The biggest DIY gains you will get is with a strict anti-acne diet. This can reduce unwanted weight & potentially clear up your skin. Add retinol, & BHA washes (how to below).
If your acne does not clear up significantly within 8 weeks, consider seeing a dermatologist for anti-hormone medications, or vitamin A creams/tablets.
What face wash is the best for patients with PCOS?
You have three choices. The wash of choice depends largely on how sensitive your skin is, & other topicals you may be using.
- La Roche Posay Micro Peel 2% salicylic acid or Cerave 1.5% salicylic acid. This wash can be purchased at any major pharmacy. It costs just over 20 bucks & lasts 5-10 weeks. Use this twice a day as directed.
- Benzoyl peroxide washes. Don’t waste your money on Proactive, simple formulations such as Benzac AC are cheaper. BPO is not suitable for sensitive skin, or patients on topical retinoids.
- Bland washes such as La Roche Posay Toleriane, Cetaphil, or Cerave are best if you are on topical or oral retinoids (or if you have uber-sensitive skin).
What topical skin care products can be used for PCOS acne?
Skin care products can be effective for some cases (they are usually more effective for normal acne, less effective for hormonally driven acne). A simple, cost-effective routine is as follows-
Wash: Twice a day with salicylic acid 2%. This acts as an anti-inflammatory & a chemical exfoliant.
Skin Care: Retinol 1% at night. Option for niacinamide 5% topically in the morning. Adapalene or Differin can be prescribed by your dermatologist. If you are more naturally inclined, you can discuss tea tree oil, witch hazel, lactic & glycolic acid with your naturopath.
Disclaimer: I am a procedural dermatologist. I do not prescribe skin care, nor do I manage PCOS. My colleagues at Cutis can assist.
Can an acne diet help?
Yes. Try an acne diet to see if this has an impact on your skin. A dairy free diet is endorsed by most dermatologists. As PCOS is a systemic disorder with elevation of blood sugar levels, modulation of a hormone known as IGF-1 or insulin like growth factor can have a significant impact on acne. A diet that is low in sugar & processed foods can help.
If you are naturally inclined, see a dietician to guide you as to what low glycaemic index foods to consume.
Disclaimer: I am a procedural dermatologist. I do not prescribe diets, nor do I manage PCOS. My colleagues at Cutis can assist.
Can hormonal acne occur if hormone levels are normal?
Yes. It is not uncommon for patients with PCOS to have normal ‘hormone’ levels. This is due to the following scenarios-
- Oil glands (that give rise to acne) are super sensitive to normal levels of hormones. This is known as intracrine dysfunction.
- Hormones present in the skin are at a higher concentration compared to the blood.
Your dermatologist may elect to investigate with special hormonal tests to exclude acne due to excess hormones from the adrenal glands, ovaries & pituitary.
Can oily skin associated with PCOS be effectively treated?
Yes. Oily skin, also known as seborrhoea, is a common finding in patients with PCOS. It is due to excess androgens or sebaceous glands (oil glands) that are sensitive to hormones. The most predictable treatments for oily skin are-
Antihormones such as spironolactone, cyproterone acetate or OCP with a combination of these compounds. Your dermatologist may prescribe oral isotretinoin in a low dose.
Topicals can be considered. They are marginally effective at best & include retinol, tretinoin, adapalene, tazarotene or trifarotene. Simple measures include –
- The use of salicylic acid washes
- Limiting face washing to twice a day at maximum
- Light moisturisers
- Products including OC8 can reduce oil
What types of oral contraceptive pills can be effective in managing PCOS?
The two main types of OCPs are pills that contain drospirinone or cyproterone acetate. These compounds are known as anti-androgens. Cyproterone acetate pills include Diane, Juliette & Brenda whilst drospirenone OCP include Yaz & Yasmin. Chlormadinone is another anti-androgen.
How long does it take before anti-hormone medications take effect?
About 3 to 6 months, so be patient. In most cases your dermatologist will prescribe you other medications concurrently. This means faster control of acne before anti-hormones kick in. Frequent combinations include-
Cyproterone acetate / spironolactone / drospirenone +/- short course anti-inflammatories (6-12 weeks). Topical medications include adapalene, trifarotene, erythromycin, benzoyl peroxide, or clindamycin.
What is spironolactone & why is it useful for treating PCOS?
Spironolactone is a long time favourite amongst dermatologists. It is an anti-androgen used to treat PCOS & hormonal acne. Spironolactone is also used as an antihypertensive drug to manage blood pressure. In the scheme of things, this medication is well tolerated by most patients. It takes 8 to 12 weeks to start working. Typical dose ranges between 50 to 150 mg daily.
Side effects include dizziness, excessive peeing & elevation of potassium levels.
Disclaimer: I do not treat acne PCOS as my work is entirely procedural. My colleagues at Cutis can assist.
When do dermatologists consider Accutane or Roaccutane for acne?
If your acne is recalcitrant to conventional therapy, including washes, topicals, diets, antihormones etc., your medical dermatologist may consider oral retinoids, namely Accutane or Roaccutane.
They will consider factors such as previous treatments, severity of acne both physically & emotionally, evidence of scarring & other important factors such as mental history, conception plans & lifestyle. Follow up is mandatory for all patients on Accutane. Side effects include mood changes, teratogenicity, elevations in liver function, cholesterol, hair loss, dry skin & about 234 more warnings. Be guided by your dermatologist.
Disclaimer: I do not treat acne. My job is procedural. If you see a dermatologist they will most likely prescribe your drugs, as this is their job. If you are after holistic treatments, do not see a dermatologist as my colleagues’ approach PCOS & acne with mainstream medical science. For a natural approach, my suggestion is that you seek advice from a naturopathic skin care guru, a herbalist, acupuncture specialist, yoga practitioner or your favourite skin care influencer.
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What are topical retinoids & how do they work in PCOS?
Retinoids are the mainstay of acne treatment no matter what the variant. They are super useful in managing PCOS & hormonal acne as they work by-
- Reducing oil or sebum production
- Reducing inflammation in sebaceous glands
- Reduce the effects of bacteria called c.acnes
- Normalize the oil gland by preventing congested skin
What are some examples of topical retinoids for acne?
Topically prescribed retinoids are much stronger than retinol. Retinoids are prescription medications, with the exception of adapalene 0.1% (can be sourced OTC in the United States). The most popular topical retinoids available in Australia are-
- Differin, Epiduo or Epiduo Forte (combination of adapalene with or without benzoyl peroxide)
- Acnatac; tretinoin & clindamycin combined
- Aklief; trifarotene
- Tazoretene compounded
- Steviel A, Retrieve; tretinoin
Disclaimer: For a prescription, book an appointment with a medical dermatologist. Note: I do not prescribe, I do not treat acne. My work is purely procedural.
Can antibiotics help in hormonal acne / PCOS acne?
Antibiotics function as anti-inflammatories. They are more useful in the management of non ‘hormonal’ acne, however, can be considered in some cases of PCOS acne. Your treating dermatologist will guide you.
The most prescribed medications include doxycycline, minocycline, erythromycin & Bactrim DS. Ideally topical retinoids are prescribed concurrently.
Disclaimer: I do not treat acne PCOS as my work is entirely procedural. My colleagues at Cutis can assist.
When do dermatologists consider Accutane or Roaccutane for acne?
If your acne is recalcitrant to conventional therapy, including washes, topicals, diets, antihormones etc., your medical dermatologist may consider oral retinoids, namely Accutane or Roaccutane.
They will consider factors such as previous treatments, severity of acne both physically & emotionally, evidence of scarring & other important factors such as mental history, conception plans & lifestyle. Follow up is mandatory for all patients on Accutane. Side effects include mood changes, teratogenicity, elevations in liver function, cholesterol, hair loss, dry skin & about 234 more warnings. Be guided by your dermatologist.
Disclaimer: I do not treat acne. My job is procedural. If you see a dermatologist they will most likely prescribe your drugs, as this is their job. If you are after holistic treatments, do not see a dermatologist as my colleagues’ approach PCOS & acne with mainstream medical science. For a natural approach, my suggestion is that you seek advice from a naturopathic skincare guru, a herbalist, acupuncture specialist, yoga practitioner or your favourite skin care influencer.
Can Kleresca be used to treat PCOS & acne?
Yes, but treatments are temporarily effective at best. Kleresca is a very old treatment that has been cleverly (but not ethnically) marketed by Leo & Laser Clinics. It is essentially photodynamic therapy activated by blue light LEDs.
Phototherapy can be useful as adjunctive management of oily skin or acne in patients who are contraindicated to conventional management.
How does phototherapy treat acne?
Phototherapy can treat acne via two ways. In the context of PCOS acne, both are temporary. You may get remission for 2-4 months if you are really lucky
Firstly, monotherapy with red or blue light LEDs. They include home LEDs, Healite, Omnilux, or IPL filters. These work by activating light-sensitive chemicals produced by c.acnes, the bacteria that are implicated in acne. Most patients undertake a series of 4-8 sessions every 1-2 weeks.
Secondly, chemicals such as Kleresca can be added. These chemicals are concentrated in the sebaceous glands. The light activates the chemicals in turn causing a photochemical reaction. The result? Temporary reduction in oil. If you are lucky.
What supplements can be helpful?
The supplement of choice in the context of chronic acne is zinc sulfate. This may have a marginal impact on your immune system. Regardless, it is banal & supplementation can be considered if you are into natural remedies.
What are emerging treatments for acne & PCOS?
Some dermatologists may elect to prescribe medications that reduce the formation of specific androgens, in particular di-hydrotesterone or DHT. These drugs include finasteride & dutasteride. They are frequently used to treat male pattern baldness, however they can be used off label for treating signs of PCOS including hair loss & in some cases acne. Be guided by your dermatologist.
Why should you consult a dermatologist for acne treatments?
The most important predictive factor for acne scarring is the time taken for effective control of acne. This is especially important in acne associated with PCOS as this form of acne is usually resistant to conventional treatment.
A dermatologist can investigate & initiate effective treatments to attain control of acne in the fastest, safest & most efficient way. This will markedly reduce the chances of permanent acne scars.
Disclaimer: I am a procedural dermatologist. For medical conditions like acne, please consult my colleagues at Clinic Cutis. My work involved management of objectively severe acne scarring.
What can a dermatologist do for PCOS & skin?
A medical dermatologist (not me) can make a difference in your skin’s health. They can manage acne effectively, reduce oil production, slow down hair loss & treat excessive hair or hirsutism.
Remember, my colleagues prescribe drugs such as anti-hormone medications, oral and topical retinoids & more. The flipside is that they will reinforce the need for lifestyle changes such as diet & exercise.
Disclaimer: I am a procedural dermatologist, I do not treat PCOS, nor do I manage acne. Please book an appointment with my colleagues @cutis
What treatments can be done to reduce acne scars from PCOS?
Scar treatments are most effective when your acne is under control, or in complete remission. Treatment depends on your scar type, skin type & downtime. As a guide-
Post-inflammatory hyperpigmentation is best treated with pigment lasers including pico laser, fractional lasers & peels.
Objectively severe scars are treated with surgical subcision, focal deep peeling agents, RF microneedling & lasers. Refer to the section on acne scars to understand the level of complexity of revision.
*A FREE assessment is provided by my nursing team at Cutis. I am only involved in the treatment of objective severe acne scars when acne is under control or in remission. If you are uncertain about the status of your acne, see my nurses for advice.
**Remission of acne is defined as absolute acne control in the context of scar patients. Failure to achieve remission usually results in on-going scars.
What are natural treatments for PCOS?
The most gain you will get from natural treatments is a combination of diet & exercise. This requires effort, in comparison to fairy treatments like supplementation (discussed below).
Diet & exercise: you need discipline. Diet can reduce glucose levels & modulate hormones. You need to carefully monitor what you eat. A dietician can assist in formulating a plan that is high in protein & low in sugar-carbs. A prescribed exercise program consisting of 2.5 hours of aerobic exercise is recommended. A personal trainer can assist.
If you are into your herbs & supplements, consult a naturopath. Natural supplements can be useful. They include-
Zinc sulphate– this supplement is useful in managing acne.
Magnesium – can help with insulin sensitivity.
Inositol – can improve insulin sensitivity.
Spearmint tea- can reduce androgens.
Liquorice extracts- can reduce androgens.
What does a common PCOS acne treatment regimen look like?
Let’s formulate a treatment plan based on all the information on this page. This acne treatment plan can be prescribed by any GP, so you do not need to see a dermatologist. There are many variations of this prescription, this is a simplified version.
Wash: La Roche Posay Effaclar Micro Peel salicylic acid wash, twice a day. You can use this on the face, neck & trunk.
Diet: Cut out dairy, sugar & processed foods.
Topical: Aklief to acne prone areas on the face, neck, & trunk.
Tablets: Diane or Yaz OCP, spironolactone 75 to 100 mg.
The above will manage 80% of PCOS patients. It will start to work at week 4, but may take 4 months or more for maximal effects. For more complex cases, book an appointment with a medical dermatologist.
Disclaimer: I do not manage acne; my work is purely procedural. Please book a consultation with my colleagues at Clinic Cutis.
Which specialists should you see if you have PCOS?
PCOS is an endocrine & metabolic disorder. You should ideally be under a team of specialists. Your family GP can coordinate referrals & monitor your progress. A PCOS team consists of –
An endocrinologist: to monitor blood sugar levels & insulin resistance. In some cases, they may prescribe metformin or other tablets to address hormonal issues.
A fertility gynaecologist specialist: is useful if you are planning to fall pregnant. See them early. It can take 2-3 years or longer to fall pregnant.
Dieticians: can guide you with foods for both acne management and weight loss.
Exercise physiologists: can help you lose weight
Dermatologists: can effectively manage skin signs of PCOS including acne, excessive body & facial hair, hair loss, oily skin, skin tags, & dark patches (acanthosis nigricans). Note, I do not treat PCOS – my work is procedural, namely treating severe acne scarring. Please see my colleagues at Clinic Cutis.
Davin’s Viewpoint on Treating PCOS Acne
There are times when having a go at DIY acne treatments are appropriate, and in many cases effective. PCOS acne is usually not one of them. The reason is that PCOS or for a broad term hormonal acne (in reality all acne is ‘hormonally mediated’), is often resistant to conventional therapy. If you do not scar, sure, climbing the treatment ladder is a sensible way to approach acne. If you are in the 70-80% of patients who scar, I do encourage you to consult a dermatologist to gain early & effective control.
The biggest predictor of acne scarring is the time taken to absolute control. It is not the time taken to initiate treatment. In the vast majority of PCOS associated acne, dermatologists rely on systemic therapy, meaning they prescribe drugs & not fairy dust. Medications prescribed include spironolactone, cyproterone acetate (either stand-alone or in combination with & an oral contraceptive) as well as oral vitamin A (isotretinoin). Some of my colleagues will also prescribe 5 alpha-reductase inhibitors such as finasteride & dutasteride.
The role of lifestyle changes & natural treatments are extremely important in PCOS. By addressing these early, it means less prescribed medications for patients. In most cases if these changes can be incorporated early in the management of PCOS, this allows your dermatologist to wean you off prescription medications. Diet has the greatest effect in the context of natural treatments. Refer to the section on acne & diet to have a better understanding. A formulated diet will treat acne, decrease adiposity (fat), & improve your overall health.
Disclaimer: I am a procedural dermatologist. I do not prescribe or manage medical conditions such as PCOS or acne. My colleagues at Clinic Cutis can assist.
