This post was updated on December 1st, 2022
By Kym Campbell, BSc. | Updated December 1st, 2022
PCOS acne isn’t a skin problem. That’s why most treatments reduce your bank balance faster than your pimples. They fail to address the underlying causes.
Here’s what you need to know about the true cause of PCOS acne and how to treat this problem. As you’ll discover, switching to a PCOS diet is essential. Get started today by downloading this free 3-Day PCOS meal plan. For more recipes and meal plans, you can also sign-up for my free 30-Day PCOS Diet Challenge. This live event delivers video lessons and activities within a supportive online community.
The Cause of PCOS Acne
It used to be assumed that acne was caused by elevated androgens, like testosterone. This hypothesis is outdated and incorrect.
Acne is now understood to be an inflammatory disease [1-4].
It occurs when inflammation in skin cells triggers two responses. The overproduction of keratin and changes in sebum composition. Keratin is a sticky skin protein. Sebum is an oily substance produced by tiny glands that empty into hair follicles.
The changes in keratin and sebum production clog pores and cause further inflammation. The immune system then produces puss in response. That’s how pimples and skin lesions form [5-8].
The buildup of sebum and keratin also provides the perfect breeding ground for acne bacteria. These bacteria help to rupture the pore wall. They can also cause more inflammation making the acne worse [5, 9, 10].
The process for acne formation is the same in women with PCOS. The big difference though is that we already have an issue with chronic inflammation. Inflammation is one of the underlying causes of all PCOS symptoms [11-15]. It’s this pre-existing problem with inflammation that makes acne a common symptom for many women with this syndrome.
There are many natural ways to reduce PCOS inflammation. Doing so can reduce symptoms. This includes acne, eczema, hirsutism, and hair loss. Reducing inflammation is how you lose weight with PCOS. It’s also key to getting pregnant with PCOS.
The treatment and prevention of PCOS acne is synonymous with the treatment of PCOS generally. Fixing PCOS resolves acne. Keep this in mind when considering the five PCOS acne treatments described below. The effectiveness of any intervention is a function of how well it reduces systemic inflammation.
1. Dietary Changes
Out of all acne treatments, a PCOS diet delivers the greatest return on investment. It’s the best way to reduce the underlying inflammation that causes PCOS. Not only does this treat acne. All other PCOS symptoms can be improved at the same time.
This can be seen in many of the success stories from my free 30-Day PCOS Diet Challenge. People often join this program because they’re fed up with ineffective treatments. It’s common for acne to be one of the first symptoms to clear.
There are three key aspects to a PCOS acne diet. Avoid foods that cause inflammation. Eat more foods that reduce inflammation. Eat in a way that improves insulin regulation.
I’ve identified seven foods to avoid with PCOS. Sugar is top of this list. But as I explain in my articles on gluten and dairy, these foods are also pro-inflammatory. Dairy, in particular, has been directly associated with acne [16, 17].
Consuming more foods that reduce inflammation is essentially about eating healthy. More than 25,000 nutrients have been identified that can only be found in plant foods. Many of these exert antioxidant and anti-inflammatory effects. This is why a good PCOS diet is rich in non-starchy vegetables. Many other whole foods can also reduce inflammation. Oily fish, avocado, nuts, seeds, and olive oil are obvious stand-outs.
Eating to improve insulin regulation is mission-critical. This is because an unhealthy diet that drives insulin resistance is another central feature of a PCOS diagnosis . Insulin resistance is caused by inflammation in women with PCOS . But insulin resistance also causes inflammation . It’s been directly implicated in the pathogenesis of acne . Improving insulin sensitivity is all about achieving tight control over blood glucose levels. I explain how to do this in my article, The Best Macros for PCOS. Studies have shown that a low-glycemic load diet reduces acne lesions [21, 22]. Eating more fiber is also important for improving insulin regulation [23, 24].
2. Acne Supplements
Many dietary supplements can help prevent and treat acne. Examine.com maintains a database of acne supplement studies. According to this database, zinc and vitamin B3 are the most well-supported acne supplements. There’s also growing interest in the use of probiotics .
Taking a PCOS-centric focus, any supplement that treats PCOS may also reduce PCOS acne.
Myo-inositol products like Ovasitol, for instance, are the closest thing to a PCOS supplement. Most studies on this supplement are about insulin sensitivity and ovarian function. But at least one study has shown that myo-inositol can decrease hirsutism and acne in PCOS women .
Because of its impact on inflammation and insulin, taking vitamin D for PCOS may also help with acne.
3. Lifestyle Solutions
As described above, both acne and PCOS are inflammatory processes. This means that other lifestyle interventions can also be an effective treatment. If something reduces inflammation, then it can reduce the severity of acne.
The most powerful evidence-based lifestyle changes are sleep, exercise, and stress reduction. I’ve described these at length in my article on natural treatments for PCOS.
Reducing psychological stress is another way to take back control of your health and well-being. Stress is known to reliably increase the circulation of inflammatory markers. A meta-analysis of the effects of stress draws an association between, “life challenges and vulnerability to inflammatory disease .” Inflammatory diseases like PCOS and acne.
4. Pharmaceutical Solutions
Oral Contraceptives and Spironolactone
There are many pharmaceutical solutions to acne. Oral contraceptives treat PCOS acne by reducing androgen levels. This can also be achieved with anti-androgenic drugs like spironolactone. The use of these medications is based on the “old” idea that excess androgens start and perpetuate the acne inflammatory cascade . As described above, we now know that inflammation precedes excess androgen production.
Metformin also has a track record as an effective PCOS acne treatment [38, 39]. Like contraceptives and Spironolactone, Metformin reduces excess androgens.
Retinoid treatments are vitamin A derivatives. They can be administered either topically (Retin-A) or orally (Accutane). These prescription medicines are stronger than over-the-counter retinol products. Topical retinoids have anti-inflammatory effects. But the main way they reduce acne is by boosting the production of new skin cells. This pushes dead cells and excess oil out of blocked pores.
Accutane is sometimes considered “the nuclear option”. It’s the single most effective drug for treatment-resistant acne . Accutane clears acne by permanently reducing skin oil production. It also reduces acne bacteria, prevents clogged pores, and reduces inflammation [41-45].
Antibiotics help stop the growth of acne bacteria from the inside out . They also have an anti-inflammatory effect [47, 48]. Antibiotics work for about half of people with acne . They’re moderately effective but can only be used for 3 months or less. This is because your acne “gets used” to the treatment and becomes resistant over time [50, 51].
Caution is warranted before using any of the above pharmaceutical acne treatments. These treatments don’t treat the underlying cause of acne. In some cases, they can do more harm than good.
For example, in my article on PCOS and birth control, I explore the risks of hormonal contraceptives for treating PCOS. I explain the seven reasons not to take metformin for PCOS here. Accutane has potentially severe side effects and must not be used if there’s the possibility of falling pregnant.
Diet and lifestyle changes are a much safer approach. They have no adverse side effects and the benefits go well beyond treating acne. Making diet and lifestyle changes is how I cured my PCOS acne. Many other women from my free 30-Day PCOS Diet Challenge have done the same. Katy is a great example.
5. Skin Treatments
Many skin treatments can provide temporary relief from PCOS acne. The most common over-the-counter product ingredients include benzoyl peroxide, salicylic acid, and azelaic acid. Chemical peels, micro-needling, and laser therapy are also often used.
If you prefer more natural skin treatments, purified bee venom gel and tea tree oil may be your best bet. Studies have found that topical use of these ingredients has helped reduce acne lesions .
The biggest shortcoming with all skin treatments is that they only “work” while you’re using them. If you fail to address the underlying inflammation then these treatments provide limited benefit.
The Bottom Line
There are many ways to prevent and treat PCOS acne. Skin treatments and pharmaceutical drugs are the most common solutions. But these treatments have limited benefits. This is because they fail to address the underlying causes. The safety and side effects of these treatments also need to be considered.
PCOS and acne are both inflammation-driven processes. Inflammation can be addressed through diet, supplements, and lifestyle interventions. The efficacy of this approach has been well-demonstrated by participants from my free 30-Day PCOS Diet Challenge. Like me, many women have eliminated their acne through diet change alone. I want this to become a more universal phenomenon.
I hope you’ll join us soon.
Ready to Take Action?
Since 2010, Kym Campbell has used evidence-based diet and lifestyle interventions to manage her PCOS. After getting her symptoms under control and falling pregnant naturally, Kym now advocates for dietary change as part of any PCOS treatment plan. Combining rigorous science and clinical advice with a pragmatic approach to habit change, Kym is on a mission to show other women how to take back control of their health and fertility. Read more about Kym and her team here.
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