PCOS & Acne

  • 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.

  1. 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.
  2. 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.
  3. 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-

  1. Oil glands (that give rise to acne) are super sensitive to normal levels of hormones. This is known as intracrine dysfunction.
  2. 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.

Davin’s Viewpoint on Treating Acne in PCOS

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 a 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 & 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.

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