Although Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder, around 70% of women worldwide go undiagnosed. It might be a common condition, but its various symptoms can significantly affect a woman’s quality of life. One of the most common symptoms associated with this condition is hormonal acne.
Understanding the connection between PCOS and hormonal acne is essential for its effective management. By addressing both the underlying hormonal issues and its skin-related symptoms, you can find relief from acne and improve your overall well-being.
What Is PCOS?
Polycystic Ovary Syndrome is a hormonal disorder that affects women of reproductive age, impacting approximately 1 in 10 women globally. The condition typically manifests through the following symptoms:
- Irregular periods. Women with PCOS may experience infrequent or absent menstrual cycles due to irregular ovulation.
- Excess androgen levels. This can lead to physical signs such as hirsutism (excessive hair growth on the face, chest and back), acne and oily skin.
- Polycystic ovaries. Although the name suggests the presence of cysts, women with PCOS typically have enlarged ovaries filled with immature eggs or follicles rather than true cysts.
- Weight gain. Many women with polycystic ovarian syndrome struggle with weight management, which can exacerbate other symptoms.
- Thinning hair. Some may experience hair loss or thinning on the scalp.
- Fertility issues. Irregular ovulation can lead to difficulties in conceiving.
- Acanthosis nigricans. This is a common symptom of PCOS, which causes dark patches of skin, often around the neck, armpits or groin. It’s linked to insulin resistance, which is common in women with PCOS.
What Is Hormonal Acne?
Hormonal acne is primarily influenced by fluctuations in hormone levels, particularly androgens such as testosterone. While it affects individuals of all ages, it is most commonly observed in adult women, often coinciding with significant hormonal changes during puberty, menstruation, pregnancy and menopause.
Unlike other forms of acne, which may arise from clogged pores or bacterial growth, hormonal acne is directly linked to hormonal imbalances that stimulate excess oil production in the skin. It also typically results in deeper cysts or nodules rather than surface-level comedones (blackheads and whiteheads), which are more characteristic of non-hormonal acne.
Characteristics of Hormonal Acne
- Location. Hormonal acne typically appears in specific face and body areas. The most common sites include:
- Jawline and chin. These areas are particularly prone to breakouts due to a higher concentration of sebaceous glands responsive to hormonal changes.
- Lower cheeks. Breakouts may also occur on the lower cheeks.
- Back and chest. Although less frequent, hormonal acne can also manifest in these regions.
- Severity. Hormonal acne often presents as deeper, more inflamed lesions than typical acne. It can manifest as:
- Cysts and nodules. These lesions are usually larger and painful, and may last longer than standard acne spots.
- Inflammation. The affected areas often exhibit redness and swelling due to the body’s inflammatory response.
- Recurrence. Hormonal acne tends to be cyclical, with flare-ups occurring at predictable times, such as just before menstruation. This pattern makes it distinct from other types of acne that may not follow a regular cycle.
How PCOS Causes Hormonal Acne
Polycystic Ovary Syndrome (PCOS) significantly contributes to the development of hormonal acne through various mechanisms, primarily involving elevated androgen levels and insulin resistance.
Androgen and Sebum Production
One of the hallmark features of PCOS is hyperandrogenism, which refers to the overproduction of androgens such as testosterone and dehydroepiandrosterone (DHEA) by the ovaries. Elevated androgen levels stimulate the skin’s sebaceous glands to produce excess sebum, an oily substance that helps keep the skin moisturised.
Sebum can mix with bacteria and dead skin cells within hair follicles when produced in excess, leading to clogged pores. This blockage creates an environment conducive to inflammation and the formation of acne lesions.
Insulin Resistance and Inflammation
Many women with PCOS exhibit insulin resistance, which elevates insulin levels in the bloodstream. This condition has several implications for skin health:
- Increased androgen production. High insulin levels can stimulate the ovaries to produce even more androgens, exacerbating hyperandrogenism and further increasing sebum production, leading to acne.
- Inflammatory response. Insulin resistance is also linked to systemic inflammation. Chronic inflammation can worsen acne by promoting the inflammatory response within the skin, leading to more severe breakouts.
Symptoms of PCOS-Related Hormonal Acne
Hormonal acne associated with PCOS presents distinct signs that can help in identifying the condition.
Key Signs of PCOS-Related Acne
- Persistent cystic acne on the lower face. Individuals with polycystic ovarian syndrome experience the presence of cystic acne, particularly on the lower face, like the jawline, chin and neck. These lesions are often deeper and more painful than typical acne, manifesting as large, inflamed bumps that can take longer to heal.
- Acne flares around the menstrual cycle. Many women with PCOS notice that their acne worsens in conjunction with their menstrual cycle due to fluctuations in estrogen and progesterone levels. The timing of these flare-ups can serve as a key indicator of hormonal involvement in acne development.
Co-occurring Symptoms
Hormonal acne in PCOS is often accompanied by other symptoms that reflect the underlying hormonal imbalance:
- Hirsutism. Excessive hair growth in areas typically considered male-pattern, such as the face (chin and upper lip), chest and back, is common among women with polycystic ovarian syndrome due to elevated androgen levels.
- Irregular periods. Absent or irregular menstrual cycles are a defining characteristic of PCOS. Women may experience long cycles, missed periods, or very short cycles due to hormonal imbalances affecting ovulation.
- Hair thinning. Some women with PCOS may experience thinning hair or male-pattern baldness due to elevated testosterone levels.
Treatment Options for Hormonal Acne and PCOS
Managing hormonal acne associated with PCOS often requires a multifaceted approach that includes medical treatments and skincare regimens.
Medical Treatments
- Oral contraceptives. Birth control pills are prescribed not only to prevent pregnancy but also to help regulate hormonal levels in women with PCOS. Certain formulations, particularly those containing cyproterone acetate or drospirenone, reduce androgen levels, which can subsequently decrease acne flare-ups. These medications help normalise menstrual cycles and lower sebum production, addressing one of the root causes of hormonal acne.
- Anti-androgen medications. Medications such as spironolactone can help manage hormonal acne by blocking the effects of androgens on the skin. This can reduce both acne and associated PCOS symptoms like hirsutism (excessive hair growth). Spironolactone is beneficial for managing hormonal acne but should be used with caution due to potential side effects, especially during pregnancy.
- Insulin-sensitising drugs. Metformin is an insulin-sensitizing medication that can help improve insulin resistance. While not specifically an acne treatment, it can help regulate hormone levels and improve skin condition by reducing androgen production.
Skincare Regimen
- Cleansers and treatments. Use gentle cleansers that do not strip the skin’s natural oils. Salicylic acid and benzoyl peroxide are typically effective for treating acne, as they unclog pores and reduce inflammation. Topical retinoids can also promote cell turnover and prevent clogged pores.
- Moisturisers. Non-comedogenic moisturisers should be used to hydrate the skin without contributing to breakouts. Look for products labeled as oil-free or non-acnegenic.
- Avoid comedogenic products. Avoid skincare and makeup products that contain comedogenic ingredients, which can clog pores and exacerbate acne. Checking product labels for terms like ‘non-comedogenic’ can help you choose suitable options.
Diet and Lifestyle Tips to Manage PCOS and Hormonal Acne
Managing diet and lifestyle can also help manage hormonal acne associated with PCOS.
Foods That Help
- Anti-inflammatory foods. A diet rich in antioxidants and anti-inflammatory properties can help combat inflammation in the body and regulate insulin levels, managing PCOS and hormonal acne.
Key options include:
- Leafy greens. Vegetables like spinach, kale and Swiss chard are high in vitamins and phytonutrients that combat inflammation.
- Nuts and seeds. Walnuts, almonds, chia seeds and flaxseeds provide healthy fats, fibre and essential nutrients that support skin health.
- Fatty fish. Consuming fish such as mackerel, salmon and sardines twice a week can supply omega-3 fatty acids, known for their anti-inflammatory effects.
- Reducing dairy and high-glycemic foods.
- Some studies suggest that dairy products, particularly low-fat options, may exacerbate acne due to their potential to increase insulin levels and androgen production.
- White bread, sugary snacks and processed carbohydrates are high-glycemic foods that may spike insulin levels and worsen insulin resistance. Opting for low-glycemic alternatives, such as whole grains, legumes and non-starchy vegetables, can help stabilise blood sugar levels.
Exercise and Stress Reduction
Stress triggers the release of a hormone called cortisol, which can increase insulin resistance and promote inflammation. This inflammatory response can worsen acne. Implementing stress management activities like yoga, meditation, deep breathing exercises or engaging in hobbies can help mitigate these effects.
Physical activity also helps lower androgen levels and reduce the severity of hormonal acne. Aim for at least 150 minutes of exercise each week, including brisk walking, cycling or swimming.
Preventing Acne Flare-Ups
Preventing acne flare-ups, particularly for individuals with Polycystic Ovary Syndrome (PCOS), involves a proactive approach that includes hormonal management, regular healthcare engagement and monitoring skin changes. Here are several strategies to prevent acne breakouts:
Balancing Hormones Through Consistent Treatment
- Hormonal treatments. Maintaining a consistent treatment regimen, such as using oral contraceptives, anti-androgen medications like spironolactone or insulin-sensitizing drugs like metformin can help regulate hormone levels and reduce sebum production, minimising the occurrence of acne flare-ups.
- Lifestyle modifications. Eating anti-inflammatory foods and reducing consumption of high-glycemic food can also support hormonal balance. Regular exercise improves insulin sensitivity, which can further help manage hormone-related acne.
Regular Check-Ups with a Healthcare Provider
- Monitoring health. Regular consultations with a healthcare provider help track the progress of treatment plans, prescribe medications and make necessary adjustments. This may involve blood tests to monitor hormone levels and assess any underlying conditions related to PCOS.
- Professional guidance. Healthcare providers can offer tailored advice on skin care routines, dietary modifications and medication adjustments based on individual responses to treatment. This ongoing support is vital for managing PCOS and PCOS symptoms long-term.
Tracking Menstrual Cycles and Skin Changes
- Cycle tracking. Keeping a record of menstrual cycles can help identify patterns in acne flare-ups related to hormonal fluctuations. Many women with PCOS experience increased breakouts around their menstrual periods due to changes in estrogen and progesterone levels.
- Observing skin changes. Monitoring skin conditions in relation to menstrual cycles can provide insights into triggers for acne flare-ups. Noting when breakouts occur can help in adjusting skincare routines or treatments.
Conclusion
PCOS impacts many women and often leads to hormonal acne. Understanding the relationship between PCOS and hormonal acne is crucial for effective management.
PCOS-related hormonal acne is recognised as persistent cystic acne on the lower face and cyclical flare-ups around menstruation.
Effective treatment options are available, including hormonal therapies like oral contraceptive pills and anti-androgen medications, as well as lifestyle modifications such as adopting an anti-inflammatory diet and engaging in regular exercise. These strategies can help balance hormones, reduce inflammation and improve skin health.
If you are experiencing these symptoms, we recommend seeking medical advice for personalised treatment plans. By making informed decisions regarding your health, you can regain control over symptoms and enhance your quality of life.
