Acne on your jawline, cheeks, chin and upper neck are all caused by PCOS. And unfortunately, nearly 30% of women with Polycystic Ovary Syndrome (PCOS) struggle with acne. It can be difficult to deal with, cause disruptions in your daily life and most importantly, they can be painful as the inflamed cysts or nodules which are formed can be hard and long-lasting. So what are the triggers of PCOS acne, which medications are helpful and what are some effective treatment options?

TC46 connected with Dermatologist Dr Smriti Naswa Singh from Fortis Hospital, Mumbai to understand all about PCOS acne. Here, she shares 10 must-know facts and treatments options about the mystery that is PCOS acne.

1. Excess Androgens lead to hormonal imbalance that causes PCOS acne

Polycystic Ovary Syndrome (PCOS)is a hormonal condition where there is an excess of Androgens (male hormones) in the body. This disturbance in the hormonal milieu in the body of a female, leads to hormonal acne of PCOS.

2. Free fatty acids and acne bacteria trigger cystic acne in PCOS patients

Hormonal acne is always more severe in form and more stubborn to treat that routine Acne Vulgaris, which occur in teens or adolescents as part of pubertal changes. The hormonal acne is severe which means grade 3 and 4. Grade 3 acne is with pus (Pustules) and grade 4 acne is with nodules and cysts. The cysts occur when the combined action of excess free fatty acids and acne bacteria (P. acnes) inside the skin eats up the walls of oil gland duct and cause excessive inflammation leading to a big cystic cavity filled with pus, bacteria, fatty acids, skin debris and more.

3. Hormonal treatment is often prescribed for PCOS-induced acne

For PCOS, the dermatologist asks you for few blood tests to check your hormonal levels. According to the reports of deranged hormones, hormonal treatment may be prescribed as per your doctor’s discretion.

  • If you only have early insulin resistance, diet and exercise with weight loss along with routine acne therapy usually suffices
  • If you have significant Insulin resistance, your doctor may prescribe you Metformin, the medicine usually given for diabetes to improve Insulin sensitivity
  • If your LH/FSH ratios are abnormal, your doctor may prescribe you with few months course of oral contraceptive pills to regularize your hormones
  • If your prolactin is in excess, your dermatologist in consultation with Endocrinologist may prescribe you medicines to control that
  • Similarly, some females come up with excess Testosterone, or excess Androgens in blood tests and accordingly medicines are prescribed as per SOPs and guidelines created by Indian and International Associations of Dermatologists

4. PCOS-induced breakout is tougher to treat than a standard breakout

The standard acne breakout has few salient features like pre-menstrual flare-up, acne in cheeks, chin, nose and forehead (T- zone involvement), a conglomerate of grade 1-4 acne. 

  • Grade 1 being black & white heads (open and closed comedowns)
  • Grade 2 being red papules
  • Grade 3 being pus-filled acne (pustules) 
  • Grade 4 being nodules or cysts

PCOS induced hormonal acne are usually more severe with more grade 3 and 4 acne than grade 1 and 2, typically more stubborn to treat; more near the lower part of the face near the angle of the jaw and sometimes near neck part of the jawline too rather than on the upper part of face or cheeks.

5. Having PCOS does not necessarily mean you will have PCOS-induced acne

The hormonal changes in PCOS can lead to a multitude of manifestations. Acne is one of them but PCOS patients do not necessarily always manifest as acne. Some have Hirsutism (hair growth on the chin, neck, mid riff), some have patterned baldness on the scalp (Androgenetic Alopecia), some have Acanthosis Nigricans (the thick band of pigmentation on the neck, armpits, inner aspect of the thigh with associated skin tags), some have obesity-related changes like abdominal fat, stretch marks on shoulders, calves, buttocks, abdomen and more.

6. Medication alone can’t eradicate PCOS acne, it needs to be accompanied by lifestyle changes

I always say to my patients that there are two phases to the treatment – active and maintenance phase. In the active phase, a patient needs to regularly come to me where I treat her with medications (oral tablets and topical creams) and I slowly prepare her for the maintenance phase. The maintenance phase is the one where she becomes her own doctor, knowing what is good for her and how to take care of her health. Medications do treat PCOS induced acne but they can always come back if the root cause of the acne problem, which is PCOS, is not dealt with properly, hence for longer-term control, I teach the patient about how to improve her lifestyle to curb the hormonal imbalance in her body and slowly but surely she can come out of her PCOS induced acne problem. You can try effective yoga asanas for PCOS, watch this video now to learn 3 yoga asanas you should practice if you have PCOS.

7. Glycolic acid and salicylic acid can bring relief from PCOS acne along with DIY face packs

The OTC products will not give great results due to hormonal imbalance being the root cause. But Glycolic acid and Salicylic acid based face washes can be tried, non-comedogenic face washes, creams containing Alpha and Beta Hydroxy acids and tea tree oil also decrease acne. Multani mitti, turmeric and chandan face packs once a week also help. Scrubs should be avoided in case the patient has active inflammatory acne.

8. Treating the root cause and prescribed medication, together, is an effective treatment plan against PCOS acne

PCOS Acne treatment needs two-pronged therapy. One is dealing with treating the root cause which is PCOS. The second is dealing with acne which needs courses of oral treatment (which can span from antioxidants, zinc, antibiotics and Isotretinoin) and topical creams (based on Benzoyl Peroxide, Tretinoin/ Adapalene) as per the treating dermatologist. With these, few fortnightly sessions of chemical peels using Alpha and Beta Hydroxy Acids and stronger formulations, help in clearing the acne faster with better treatment of post-acne pigmentation.

9. Diet, weight loss & exercise are effective solutions for all PCOS related problems

Absolutely. Diet and lifestyle are the most important factors for having PCOS, and hence treating PCOS is incomplete without weight loss, diet and exercise.

Foods to eat in PCOS: The focus is to have fibre in the diet to improve hormonal balance. Fibre-rich foods are whole grains, millets, legumes, cereals, nuts, seeds, fruits and vegetables. The focus is also on vitamins and minerals hence having fruits and vegetables in raw form help a lot.

Foods to avoid in PCOS: There are some foods that are called ‘endocrine disruptors’, especially when taken in excess; they should be avoided. Foods with no fibre or foods injected with hormones (dairy, eggs, meat, sea food). These foods should be had 1-2-3 times a week and the preferred source animals should be freely grazing, organic grass or grain-fed, and hormone-free. Ultra-processed and ultra-refined plant foods like maida, refined sugar, white rice are devoid of fibre. Instead, one should switch to millets, single hand-pounded local varieties of rice, jaggery and dates. 

10. Tips for PCOS patients to get and maintain flawless skin

  • Weight loss and having BMI less than 23 should be the first target
  • Weight loss with only food changes doesn’t suffice, exercise is equally important where strength training is more important than cardio
  • Consume fibre-rich foods and eating fresh home-cooked meals rather than packaged foods
  • Use a moisturizer which is non-comedogenic.
  • Use a face wash with Glycolic acid or Salicylic acid (always check for sensitivity, by applying on back of the ear for 48 hours before using on the face)
  • Consult your dermatologist, because treating acne is easier than treating dark spots or scars left after acne