Polycystic ovarian syndrome (PCOS) is a common condition that affects the way a woman's ovaries work. Believed to affect one in five women in the UK, PCOS is a hormonal disorder that causes enlarged ovaries with multiple small cysts on the outsides of the ovaries, due to the follicles not maturing into eggs (i.e., lack of ovulation). The exact cause of PCOS is unknown and the symptoms vary, which can sometimes make it difficult to diagnose.
A diagnosis of PCOS is made if you have two of the following: irregular periods, polycystic ovaries seen on pelvic ultrasound, and symptoms of excess male hormones such as resistant acne, hair loss, and/or excessive hair growth in unusual places (known as hirsutism), explained Dr Amelie Seghers, consultant dermatologist at the Cadogan Clinic. We wanted to find out more about the latter and what you can do to treat PCOS-related acne, tapping Dr Seghers, GP skin specialist Dr Ross Perry, and Pamela Marshall, clinical aesthetician and cofounder of Mortar & Milk, for help.
Can PCOS Cause Acne?
In short: yes, it can. "About 70 percent of patients with PCOS will suffer from some form of acne," Dr Seghers told POPSUGAR. And it's probably more than just the odd breakout.
Dr Seghers explained that acne seen in patients with PCOS is likely to be more resistant to conventional acne treatments, especially if there is evidence of an underlying hormonal imbalance. "Classically, testosterone is elevated in PCOS (although, not always, it can be normal), however other hormones such as LH, FSH, estrone, and progesterone can also show abnormal values." she said. "The excess of male hormones, also known as hyperandrogenism, is what often drives the acne and excess hair in patients with PCOS," she continued. "An excess of male hormone can trigger the excess sebum in the skin and dead skin cells that get trapped in the hair follicles, causing breakouts", Dr Perry added.
What to Do If You Think Your Acne Is Caused by PCOS
"PCOS is a complex disease as the signs and symptoms can vary a lot from one person to another," said Dr Seghers. "In addition to this, the management can require the input of more than one doctor — a GP, gynaecologist, and dermatologist in some cases." Dr Seghers went on to explain that your doctor might ask you to do a female hormone profile (usually a blood test), as well as a pelvic ultrasound to help make the diagnosis. If PCOS is suspected or confirmed, additional investigations like blood-sugar levels, cholesterol checks, and blood-pressure tests may be required.
At this point in your diagnosis, a treatment plan for any acne-related symptoms (should you choose to treat your acne) can be made.
What Treatment Options Are Available For PCOS-Related Acne?
As Dr Seghers touched on, acne due to PCOS can often be resistant to conventional treatments, including topical creams and antibiotics. Because of this, it may require hormonal treatment, or a medication called isotretinoin (Roaccutane). This medication is strong and requires regular monitoring, so your doctor will tailor your treatment depending on your symptoms and further investigations.
"Lifestyle measures do play an important role in all patients with PCOS and should include regular (cardiovascular) exercise and nutritional intervention (low glycemic index diet and reduced sugar)," said Dr Seghers. "It is vital to balance blood sugar levels, and sometimes the drug metformin will be considered to help regulate the sugar uptake," she added.
Marshall recommended mandelic acid, "which is a lipophilic acid that is excellent at decongesting our pores, and PHAs which will force cell turnover, hydrate, and reduce inflammation." Clinisept is another of Marshall's suggestions: "It's not an ingredient, but it is an excellent spray-on product for all acne, as it is antibacterial and a wound healer."
Dr Perry also noted that some facials, including light therapy, can be a great additional treatment, as it works well to kill the bacteria. However, he warned to stay clear of harsh treatments — like microdermabrasion (which uses fine crystals and a vacuum to exfoliate the skin) and enzyme peels (which removes dead skin cells by exfoliating the upper layers of the skin) — as these may lead to further inflammation and irritate the skin.