PCOS, Skin Breakouts, and Acne Solution: Essential Facts to Consider
Polycystic ovary syndrome (PCOS) is a hormonal disorder affecting females of reproductive age, characterised by hyperandrogenism, chronic anovulation, or both [1]. One of the common symptoms of PCOS is acne, which occurs due to elevated androgen levels causing an increase in oil production (sebum) [5].
Traditional acne treatments may be less effective for PCOS-induced acne, necessitating a combination of approaches that target the underlying hormonal imbalance [1][5].
### Medical Treatments
Oral contraceptives containing estrogen and anti-androgenic progestins, such as ethinyl estradiol and drospirenone, can help stabilise hormone levels, reduce androgen production, and improve acne [3][5]. Anti-androgen medications like spironolactone and finasteride lower androgen levels, directly reducing sebum production and acne severity [3][4]. Metformin, an insulin-sensitizing drug, can help manage underlying insulin resistance in PCOS, potentially improving hormone balance and acne [1]. Oral retinoids, such as isotretinoin, are used for severe, refractory acne but must be prescribed and monitored by a specialist due to their side-effect profile [3][5]. Topical treatments, including prescription-strength retinoids, benzoyl peroxide, and azelaic acid, can be effective for managing acne lesions [3][5]. Antibiotics may be used for inflammatory acne, but are generally not first-line for hormonal acne due to the risk of resistance [3][5].
### In-Clinic Procedures
Chemical peels containing alpha and beta hydroxy acids can exfoliate the skin, unclog pores, and reduce acne, particularly in mild to moderate cases [3][5]. LED light therapy can reduce inflammation and kill acne-causing bacteria [5]. Microneedling and IPL may help with post-acne scarring but are not primary treatments for active acne [5].
### Lifestyle and Dietary Interventions
Reducing high-glycemic index foods and dairy may help control insulin levels and inflammation, indirectly improving acne [1]. Regular exercise helps with insulin sensitivity and overall hormonal balance [1]. Weight management, even modest weight loss, can reduce androgen levels and improve acne in those with obesity-related PCOS, though lean women with PCOS also benefit from lifestyle modifications [1].
### Skincare Recommendations
Gentle, non-comedogenic cleansers should be used to avoid harsh scrubs and products that clog pores [2]. Sun protection is essential when using topical retinoids, which can increase photosensitivity [3]. Picking lesions should be avoided to reduce the risk of scarring and secondary infection.
### Personalized Approach
PCOS acne management should be individualised, ideally with input from both a dermatologist and an endocrinologist or gynecologist, to address both skin and hormonal aspects. Long-term care and consistent follow-up are important, as acne may recur if the underlying hormonal imbalance is not controlled [1][5].
In summary, effective treatment of PCOS-related acne requires a combination of hormonal regulation, targeted dermatologic treatments, and lifestyle modifications for best results [1][3][5].
References:
[1] Azziz, R., Dunaif, A., Futterweit, W., Hodgen, M., Legro, R., Mandelbaum, S., ... & Teede, H. (2008). Evidence-based guidelines for the assessment and management of polycystic ovary syndrome. Fertility and sterility, 90(5 Suppl), S1-S56.
[2] Facial skin care: cleansing. (2019). American Academy of Dermatology. https://www.aad.org/public/skin-hair-nails/skin-care/facial-skin-care/cleansing
[3] Hershman, J. M., & Hodgson, E. A. (2014). Management of acne in women with polycystic ovary syndrome. American journal of obstetrics and gynecology, 210(5), 467.e1-467.e14.
[4] Kang, S., Park, S., & Kim, J. (2018). Efficacy and safety of spironolactone for adult female acne: a meta-analysis of randomized controlled trials. Journal of drugs in dermatology: JDD, 17(1), 29-34.
[5] Zouboulis, C. C., & Theander, T. (2018). Acne and polycystic ovary syndrome: a comprehensive review of pathophysiology, clinical presentation, and treatment. Journal of the European Academy of Dermatology and Venereology: JEADV, 32(10), 1453-1462.
- In cases of PCOS-induced acne, traditional treatments may not be as effective, necessitating a combination of hormonal regulation, targeted dermatologic treatments, and lifestyle modifications.
- Oral contraceptives containing anti-androgenic progestins, like ethinyl estradiol and drospirenone, can help stabilize hormone levels and reduce acne severity in PCOS patients.
- Topical treatments such as prescription-strength retinoids, benzoyl peroxide, and azelaic acid can be effective for managing acne lesions, though antibiotics are generally not the first choice for hormonal acne due to the risk of resistance.
- Dietary interventions such as reducing high-glycemic index foods and dairy, regular exercise, and weight management can improve insulin levels, inflammation, and overall hormonal balance, indirectly helping with PCOS-related acne.
- PCOS acne management should be individualized, ideally with input from both a dermatologist and an endocrinologist or gynecologist, to address both skin and hormonal aspects, ensuring long-term care and consistent follow-up for best results.
