Polycystic ovary syndrome (PCOS) and Acne Vulgaris

Polycystic ovary syndrome (PCOS) is a common hormonal condition that affects women of all ages, symptoms may begin during puberty but may persist for the entirety of the patient’s reproductive years. Patients with PCOS have varied symptoms, some present with no symptoms at all, making it difficult to diagnosis, whereas others may have one or more of the common symptoms of irregular periods, infertility, weight gain, and/or acne. Among the many skin-related issues associated with PCOS, acne is one of the most common.

Polycystic ovary syndrome (PCOS) and Acne Vulgaris

What is PCOS?

PCOS is a condition where a woman’s hormone levels become imbalanced, leading to a variety of symptoms. The name "polycystic ovary syndrome" comes from the fact that many women with PCOS have numerous small cysts (fluid-filled sacs) on their ovaries. These cysts result from follicles that fail to mature and release eggs, disrupting the normal reproductive cycle.

The exact cause of PCOS is still not fully understood, but it is thought to involve a combination of genetic and environmental factors. Women with PCOS often have elevated levels of androgens, or "male" hormones, such as testosterone. This hormonal imbalance can lead to irregular periods, difficulty getting pregnant, excess hair growth (hirsutism), and acne.

What is PCOS?

How is PCOS Diagnosed?

Diagnosing PCOS can be challenging due to overlapping symptoms with other conditions. Patients with fewer symptoms may experience delays in diagnosis. Typically, PCOS is diagnosed using a combination of:

Clinical Symptoms: Irregular periods, acne, excess hair growth (hirsutism), and weight gain.

Blood Tests: Elevated androgens (testosterone, DHEA-S) or insulin resistance.

Ultrasound: Checking for small ovarian cysts, though not all women with PCOS have them.

Diagnosis requires at least two of three criteria: irregular or absent ovulation, elevated androgens, or polycystic ovaries on ultrasound.

Hormonal treatment
Combined oral contraceptives (COCs) containing estrogen and progestin are commonly prescribed for women with PCOS to regulate menstrual cycles, reduce testosterone levels, and decrease oil production in the skin. Birth control pills are often the first-line treatment for PCOS-related acne.

Anti-Androgens (Spironolactone): Spironolactone is a medication that blocks the effects of androgens (male hormones) in the body. By reducing the levels of testosterone, spironolactone can help decrease sebum production, thereby improving acne. It’s often used in conjunction with birth control pills.
Topical Treatments
Topical Retinoids: Retinoids, like tretinoin, are commonly used to treat acne. They work by speeding up cell turnover, preventing clogged pores, and reducing inflammation. Retinoids can be especially helpful for women with PCOS, as they help manage the clogged pores caused by excess sebum production.

Benzoyl Peroxide & Salicylic Acid: Over-the-counter acne treatments containing benzoyl peroxide or salicylic acid can help reduce acne breakouts. These products target bacteria and help to clear clogged pores, making them effective for mild to moderate acne.
Lifestyle, dietary and other treatments
A low-glycemic diet, rich in whole foods, lean proteins, vegetables, and healthy fats while avoiding refined sugars and processed carbs, may help manage insulin resistance, hormonal balance, and acne in women with PCOS.
Regular exercise supports weight management, reduces insulin resistance, and regulates blood sugar levels, promoting better skin health and alleviating PCOS symptoms like acne.
For insulin resistance, metformin may be prescribed to improve insulin sensitivity, lower androgen levels, and reduce acne. It is also commonly used for women trying to conceive by addressing hormonal imbalances and enhancing fertility.
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