Polycystic ovary syndrome (PCOS) is a hormonal disorder that is common among females of reproductive age.
People with PCOS can have a wide range of symptoms and clinical signs. Acne is common, affecting 10–34% of people who have the condition.
In this article, we explore the link between PCOS and acne. We also describe treatment for acne caused by PCOS and ways to manage other symptoms of the condition.
One of the key features of PCOS is high levels of hormones called androgens. Doctors call this hyperandrogenism.
Androgens play an important role in the development of acne. They cause the glands in the skin to produce an excess of an oily substance called sebum.
Acne occurs when sebum and dead skin cells build up inside hair follicles, trapping bacteria beneath the skin. This leads to inflammation and the formation of pimples.
Someone with PCOS may develop acne in various areas, including the:
- upper back
Several other health issues are associated with PCOS, including:
- metabolic syndrome
- impaired glucose tolerance
- type 2 diabetes
- cardiovascular risk
- obstructive sleep apnea
- nonalcoholic fatty liver disease
In order to make a diagnosis of PCOS, a doctor needs to find at least two of the following three issues:
Excess androgen production, or hyperandrogenism, is a defining feature of PCOS. To diagnose it in a female, a doctor looks for:
- loss of hair from the head
- hirsutism, which refers to excessive hair growth in areas where hair is usually absent
Anovulation refers to the ovaries not releasing an egg cell during the menstrual cycle.
People with PCOS may experience chronic anovulation — a menstrual cycle that typically lasts more than 35 days, in adults, or more than 40 days, in adolescents.
Chronic anovulation can cause infertility.
There are two defining features of polycystic ovaries:
- enlargement of the ovaries
- the presence of many fluid-filled sacs, called follicles, around the egg cells
In order to determine whether someone has polycystic ovaries, their doctor or gynecologist will perform a transvaginal ultrasound.
Some oral contraceptive pills can treat acne that results from PCOS. The combination of estrogen and progesterone in these pills reduces levels of testosterone in the body.
A reduction in testosterone limits the development of acne and hirsutism.
Not all oral contraceptives are equally able to treat acne caused by PCOS. Two types of progesterone — called cyproterone acetate and drospirenone — block the effect of androgens and work particularly well for this purpose.
Researchers have found a 30–60% reduction in inflammatory acne within 3–6 months of oral contraceptive therapy. They estimate that 50–90% of people who receive this treatment see an improvement in acne lesions.
Two other medications, called spironolactone and flutamide, may also treat acne and hirsutism caused by PCOS.
However, the Food and Drug Administration (FDA) have not approved them for these uses, so a doctor would be prescribing them on an off-label basis.
Doctors recommend that people with PCOS-induced acne follow general advice about caring for their skin and preventing breakouts, such as:
- washing the face twice a day and after sweating
- avoiding scrubbing the skin
- applying a nonabrasive cleanser with the fingertips, as opposed to a washcloth or sponge
- rinsing the skin thoroughly with lukewarm water
- avoiding touching, squeezing, or popping pimples
- avoiding excess sun exposure, including tanning beds
Currently, there is no cure for PCOS, but a doctor can prescribe medications and make recommendations to help manage the symptoms and any complications.
Some people with PCOS take a medication called finasteride to treat hirsutism. Combining this with spironolactone can sometimes control excessive hair growth.
People also use nonmedical techniques, such as:
A person may also try a more permanent method of hair removal, such as electrolysis or photoepilation.
Insulin resistance, diabetes, and obesity
Doctors may recommend diet and lifestyle modifications for people who have PCOS and a body mass index greater than 25 or a diagnosis of insulin resistance or type 2 diabetes.
Dietary restriction, exercise, and weight loss can reduce insulin resistance and testosterone levels, improving cardiovascular risk factors.
Some people with insulin resistance or type 2 diabetes take metformin, which can also help with weight reduction.
Meanwhile, certain dietary changes may lessen the effects of PCOS.
PCOS is frequently associated with obesity and insulin resistance, and researchers have shown that weight loss and increased insulin sensitivity can help control the metabolic and hormonal features of PCOS.
Health experts tend to also recommend weight loss for people with type 2 diabetes, as this condition, like PCOS, is associated with obesity and other cardiovascular risks. They suggest that people with type 2 diabetes adopt diets low in carbohydrates.
In 2006, researchers conducted a small study in 11 women to determine whether a low-carbohydrate diet may also help with the metabolic manifestations of PCOS.
To test the effect of dietary changes, and not weight loss, on metabolic and hormonal features of PCOS, the researchers designed the diet in their study so that the number of calories consumed was the same as the number expended. The goal was to limit any weight loss that could otherwise have influenced the results.
The researchers found that this diet reduced key metabolic factors and testosterone levels, while other hormonal factors remained unchanged.
They concluded that a diet low in cholesterol and carbohydrates and high in fiber and monounsaturated fatty acids could improve metabolic features of PCOS within 16 days.
Overall, adopting a low-carbohydrate diet and following a weight loss plan may have benefits for people with PCOS and obesity or type 2 diabetes.
Previous studies have explored the effects of diets with low amounts of calories and high or low levels of protein in people with PCOS. However, these interventions did not result in metabolic or hormonal changes.
Another, limited study evaluated the effects of a diet rich in polyunsaturated fatty acids from walnuts. The researchers likewise found that adopting the diet had no helpful effects.
Significant limitations in these studies, including small numbers of participants and short study periods, make it difficult to draw conclusions. Determining whether an optimal diet can help with PCOS symptoms and clinical signs will require further research.
PCOS can lead to acne because it causes the ovaries to produce more hormones called androgens, which stimulate the production of oil in the skin.
Someone with PCOS may have acne on their face, back, neck, and chest.
Because hormonal imbalances cause acne in people with PCOS, doctors often prescribe treatments that act on hormones.
Oral contraceptive pills and medications called spironolactone and flutamide can treat acne caused by PCOS, though the FDA have not approved the latter two for this use.
Some people feel embarrassed or experience low self-esteem due to PCOS symptoms. It is important to speak with a doctor, who can help determine the cause of acne and other related issues and provide effective treatment.