Have PCOS? Here’s Everything You Need To Know About Acne and Other Skin Symptoms

Hormones play a role in every organ in your body, including your skin. So, it’s no surprise that a hormonal condition like polycystic ovary syndrome (PCOS) can cause a variety of skin problems, from acne breakouts to hair thinning.

If you’re dealing with PCOS skin issues, you’re not alone — and you don’t have to accept them as an inevitable part of life. Ob/Gyn Jacqueline Zuponcic, DO, explains the link between PCOS and acne, other PCOS skin symptoms and how to treat them.

The PCOS and acne connection

When you have PCOS, your ovaries make higher levels of the androgen hormones testosterone and dehydroepiandrosterone (DHEA).

“Testosterone and DHEA tell your skin’s sebaceous glands to produce more oil,” explains Dr. Zuponcic. “These hormones can also slow down your skin’s turnover rate, making the oil more likely to clog your pores. Together, these two factors lead to acne.”

What does PCOS acne look like?

Nearly everyone has experienced acne at least once, and it can strike at any age. So, how do you know if the breakouts are due to PCOS or something else?

PCOS acne is a type of hormonal acne, which can be more severe than other breakouts. If you have acne from PCOS, it’s more likely to be:

• Deeper under your skin, like cystic acne.
• Lower on your face, such as on your chin, jawline or lower cheeks.
• Red and inflamed (acne papules).

One of the other telltale signs of PCOS acne is its flat-out refusal to ... Just. Go. Away.

“You might try acne creams and take great care of your skin, but the breakouts persist,” says Dr. Zuponcic. “This resistance to standard treatment can be a sign that the acne products aren’t addressing the root cause, which is hormones.”

If you get an occasional pimple or a few blackheads, it’s probably not related to PCOS. But, Dr. Zuponcic says, doctors don’t diagnose or rule out PCOS based on the appearance of your skin. “Some people with PCOS get mild acne or no acne at all,” she notes. “Your provider may need to run other tests, such as hormone testing or an ultrasound, to confirm a PCOS diagnosis.”

PCOS acne treatment

There’s no single acne treatment that’s right for everyone. But luckily, there are a few effective options for kicking PCOS acne to the curb, including:

Oral contraceptives (birth control pills)

Certain oral contraceptives decrease the hormones that trigger acne.

“Birth control pills can improve acne for many people — with or without PCOS,” shares Dr. Zuponcic. “However, not all types of oral contraceptives have this effect. People with PCOS should talk with their provider to determine which medication is best for their needs.”

Spironolactone

This medication was first prescribed to treat high blood pressure and edema (fluid retention). But healthcare providers discovered spironolactone had a positive side effect: It improved acne.

“Spironolactone may be effective against hormonal and PCOS acne when other treatments haven’t worked,” says Dr. Zuponcic. “This medication is safe for most adults assigned female at birth (AFAB), but you shouldn’t get pregnant while taking it because it can harm a developing fetus.”

Topical acne medications

Over-the-counter (OTC) and prescription topical medications can help many cases of acne, and they can improve PCOS acne, too.

“Benzoyl peroxide and salicylic acid are effective OTC treatments that can help with mild to moderate acne,” shares Dr. Zuponcic. “These are also generally safe to use during pregnancy, unlike spironolactone and oral contraceptives.”

If OTC products aren’t enough, your provider may recommend prescription topical medications.

“If you’re not planning to get pregnant, you can also combine topicals with spironolactone, birth control pills or both,” she adds.

Other PCOS skin symptoms

Acne isn’t the only condition you might face if you have PCOS. Other PCOS skin symptoms can include:

Acanthosis nigricans

If you spot brown or black patches on your skin and have PCOS, you might have acanthosis nigricans. Often, these patches are a result of insulin resistance, which is common in people with PCOS.

“Acanthosis nigricans isn’t harmful, but it may be a sign that you have insulin resistance,” explains Dr. Zuponcic. “If you notice any changes in your skin color, talk to your provider so you can find out the cause.”

Many people see improvement or disappearance of acanthosis nigricans patches with:

• Diabetes medications: If you have diabetes or insulin resistance, medications can help manage the condition and treat the dark spots.
• Topical retinoid medications: Prescriptions like tretinoin cream can lighten acanthosis nigricans but won’t get to the root cause. “Dark spots may continue to appear without treatment for insulin resistance,” says Dr. Zuponcic.
• Weight loss: If you have excess weight, losing weight can help reduce insulin resistance and improve your symptoms. And it doesn’t have to be a significant loss to see the effects. “Losing just 5% of your body weight can make a difference,” she says. “But some people benefit from obesity treatment, including medications or bariatric surgery.”

Dandruff

Dandruff is a form of seborrheic dermatitis that can cause a flaky, itchy scalp.

“Higher androgen levels trigger dandruff, which is why many people with PCOS have this condition,” says Dr. Zuponcic. “If the symptoms bother you, use an OTC dandruff shampoo three to four times a week. If the OTC shampoo isn’t effective enough, ask your provider about prescription dandruff treatments.”

Hair thinning or hair loss

Higher androgen levels in PCOS can cause androgenic alopecia (female pattern baldness).

“Lowering your androgen levels with spironolactone or oral contraceptives can help you keep more hair on your head,” says Dr. Zuponcic. “Some topical hair loss treatments, including minoxidil, may also work well.”

Hirsutism

While you might see hair loss on your head, the opposite can happen in other places. PCOS can cause hirsutism, or excess hair growth on your face, neck, chest or back.

“Hirsutism isn’t harmful to your physical health, but it can cause emotional distress for some people,” notes Dr. Zuponcic. “Hirsutism often responds well to birth control pills, spironolactone or both.”

PCOS skin issues: You have options

Acne and other PCOS skin problems can interfere with your self-confidence and enjoyment of life, but there’s hope. Your healthcare provider can help you find treatments to manage these issues.

“Many people are told that acne, hair growth or other PCOS symptoms are just something they have to live with, but this isn’t the case,” reassures Dr. Zuponcic. ”Safe, effective therapies are available and you deserve a chance to look and feel your best.”