Polycystic ovary syndrome (PCOS) and acne

PCOS-related acne has multiple causes, mainly driven by the high level of androgens in the body. With PCOS acne, you are more likely to have cystic acne, which can appear as deep inflammatory pus-filled red spots on the lower half of the face, the so-called muzzle distribution. These are painful, take a while to resolve, and carry the risk of scarring.

Regular acne tends to appear more superficially on the skin as non-inflammatory whiteheads and blackheads, typically in the oily T-zone.

In PCOS, the ovaries produce more of a group of hormones called androgens, including testosterone. Androgens cause the glands in the skin to produce sebum, an oily substance. When sebum is trapped under the skin alongside other dead skin cells and bacteria, it can lead to acne, commonly in the face, neck, shoulders, and back.

PCOS can go hand-in-hand with insulin resistance, and PCOS acne can be sensitive to high circulating sugar levels, alongside chronic inflammation, stress, and bacterial infections.

To reduce the presence of acne, it is recommended that you cleanse the face twice daily with lukewarm water and after excessive sweating. It is important to avoid using anything abrasive on your skin, such as scrubbing or using applicators and sponges, as this can cause more inflammation and sebum production. Make sure any moisturizers and make-up have a non-comedogenic label.

Avoid anything that will irritate, like some perfumed products. Although tempting for some, spots should be left alone and not squeezed or popped, as this spreads bacteria around the face and worsens inflammation.

If acne is causing you distress and you’ve tried over-the-counter treatments, or you have inflammatory spots or signs of scarring, you should see your doctor.

They may offer certain creams, gels, or lotions. They will often offer these in combination with certain antibiotics. These are chosen for their anti-inflammatory properties and offered on a long-term basis – it can take a few months to see an effect.

As androgens like testosterone increase in PCOS, oral contraceptives are effective for reducing acne as the combination of estrogen and progesterone reduces testosterone levels.

Any combined hormonal contraceptive is more likely than not to have a positive effect, but some are better than others. Cyproterone acetate and drospirenone (brand name Yasmin) have stronger anti-androgenic effects but carry a higher risk of blood clots, so they are not suitable for everyone. Speak to your doctor about starting an effective oral contraceptive.

If these treatments don't work, or you can’t tolerate the side effects, your doctor may refer you to a dermatologist to consider alternative medications such as tretinoin (brand name Retin-A) or spironolactone.

Dermatologists and aestheticians can consider chemical peels and laser therapies.