The Channel 46
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.
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.
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
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
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.
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.
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.
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.
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.
– 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
The Channel 46