Polycystic ovary syndrome (PCOS) is a common hormonal condition affecting up to 13% of females of childbearing age. Symptoms often include acne, irregular periods, and weight gain.
Studies show that people with PCOS are more likely to experience persistent and severe acne compared to people without the condition. PCOS-related acne is more challenging to treat, often requiring a combination of lifestyle changes, skincare routines, and hormonal medications.
PCOS acne results primarily from hormone imbalances. Bacteria and genetics can also contribute.
Hormone Imbalances
PCOS disrupts hormone balance by lowering female hormones like estrogen and raising male hormones (androgens) like testosterone.
Females naturally produce small amounts of androgens. In people with PCOS, androgen levels become too high, triggering the skin to produce more oil, causing clogged pores and leading to acne.
Insulin Resistance
Many people with PCOS also have insulin resistance, which occurs when the body doesn’t properly use insulin, the hormone that controls blood sugar. This imbalance increases insulin levels, triggering the ovaries to produce more androgens. As mentioned above, higher androgen levels in females can cause overproduction of oils, leading to acne.
High insulin can also lower sex hormone-binding globulin (SHBG), a protein that helps control testosterone. Low SHBG makes testosterone more active, triggering the skin’s oil production.
Bacteria
Hormonal imbalances and insulin resistance lead to excess oil production, clogging pores and creating an ideal environment for growing bacteria like Cutibacterium acnes or Propionibacterium acnes. This bacteria growth can result in:
- Papules: Red, tender bumps
- Pustules: Pimples with white centers
- Nodules: Large, painful lumps under the skin
- Cysts: Deep, pus-filled bumps that may scar
Genetics
Genetics can affect the severity of acne by influencing hormones, oil glands, and oil production. If acne runs in your family, you are also more likely to have it.
PCOS acne is persistent, often appears on the lower face, and can cause deep, painful cysts that may fill with pus and take a long time to heal. If you think your acne might be related to PCOS, consult a healthcare provider. They may refer you to a dermatologist or endocrinologist (doctors specializing in skin- and hormone-related conditions, respectively).
To diagnose PCOS, your provider will review your symptoms and medical history and perform a physical exam. They will likely ask about or look for common PCOS symptoms like:
- Dark patches of skin
- Difficulty getting pregnant
- Excess hair growth (hirsutism)
- Irregular or absent periods
- Oily skin
- Ovarian cysts (fluid-filled sacs on the ovaries)
- Weight gain
Your provider may order blood tests to check levels of hormones like testosterone, estrogen, insulin, and cortisol (the stress hormone). They may order an ultrasound to look for ovarian cysts. Providers can also use acne severity scales to help confirm the diagnosis and guide treatment decisions.
Experts suggest starting with milder treatments for PCOS acne, such as home remedies and over-the-counter (OTC) products, and only moving to stronger prescription treatments if necessary.
Natural Home Remedies
Many natural home remedies are touted for treating and managing acne but have minimal research to support their effectiveness. Home treatments may also not improve severe acne. Talk to your healthcare provider or dermatologist about safe and effective home remedies.
Steam and Cleanse
While facial cleansing will not treat the root cause of hormonal acne, it can help manage oil buildup and potentially reduce the severity.
To open your pores, soak a clean face cloth in warm water and wring it out until damp. Place the warm (not hot) cloth on your face and let it sit for a few minutes. Then, cleanse your skin with a mild soap or cleanser. Pat dry and apply your skincare products as usual.
Herbal Treatments
Many plants have anti-inflammatory and antibacterial properties that may help soothe, treat, or prevent acne. Keep in mind natural elements can still irritate the skin, and the application methods for each herbal treatment may differ. Use essential oils with a carrier oil to prevent irritation.
Research shows the following herbal ingredients may help treat or manage acne:
Potato Peel Remedy
Plain, uncooked white potato peels can be a topical home remedy for acne. They are rich in natural compounds like tannins, phenols, and antioxidants, which give potatoes antibacterial, skin-healing, and detoxifying effects.
Applying potatoes to the skin helps remove impurities and pus, tighten and brighten the skin, and reduce inflammation, making them effective for treating acne, minor wounds, and excess oil. Their water, starch, and potassium help soothe, heal, and refresh the skin.
A few methods for applying potatoes to your skin include:
- Place the white part of the potato peel directly on your skin
- Mash the potato peel to create a poultice (paste)
- Extract potato juice and use a cotton ball to apply it
Leave the potato or mixture on for 15–20 minutes before rinsing with warm water.
Over-The-Counter Treatments
You can find acne-fighting ingredients in over-the-counter (OTC) cleansers, creams, gels, toners, or spot treatments. Here are some standard options:
- Benzoyl peroxide: Helps clear bacteria
- Salicylic acid: Unclogs pores and reduces redness
- Retinoids: Vitamin A derivatives that speed up skin cell turnover to clear pores
- Azelaic acid: Reduces inflammation, kills bacteria, and helps fade dark spots or acne scars
Prescription Treatments
Topical prescription treatments may include Clindagel (clindamycin), an antibiotic gel that targets bacteria. Providers often combine this with benzoyl peroxide for maximum benefit.
Other prescriptions use the same ingredients as OTC products but in higher concentrations. For example, Finacea and Azelex are prescription-strength azelaic acid. Retin-A (tretinoin) and Tazorac (tazarotene) are stronger retinoids.
Oral medications may include antibiotics like Minocin (minocycline) and Vibramycin (doxycycline) to help fight bacteria from the inside. Providers may prescribe Accutane (isotretinoin), an oral retinoid that shrinks oil glands for severe acne that doesn’t respond to other treatments. It’s essential to pair it with birth control, as it could cause harm to a developing fetus.
Because hormone imbalance causes PCOS acne, you may find hormonal therapy, like combination birth control pills, more effective. Another hormonal option is antiandrogens like Aldactone (spironolactone), which block androgens. Providers also pair this with birth control to prevent pregnancy.
Making lifestyle changes to balance hormones, reduce inflammation, and care for your skin may also help manage PCOS acne.
Skincare Habits
To get the best results from your skincare treatment, try these tips:
- Avoid picking or popping pimples, which can worsen acne and leave scars or dark spots
- Choose non-comedogenic skincare and makeup that won’t clog pores
- Don’t switch acne treatments too quickly; they may take a few weeks to work
- If your hair is oily, shampoo it more often and style it to keep it away from your face
- Use a gentle cleanser to wash your face twice daily and after sweating
Diet and Hydration
Certain foods can raise blood sugar or insulin levels, increase oil production, and worsen inflammation, leading to more breakouts. Making specific food choices can help balance hormones, reduce acne, and improve overall skin health. Here are some tips:
- Limit refined carbohydrates (e.g., sweets, white bread, dairy, sugary drinks) to mitigate blood sugar spikes and inflammation factors
- Prioritize vegetables, berries, lean proteins, and healthy fats (e.g., avocado, nuts, coconut oil) to keep hormones steady
- Drink plenty of water to keep your skin hydrated and reduce oil buildup
Exercise and Stress Management
Regular exercise helps balance hormones and improve insulin sensitivity, reducing acne triggers.
High stress can worsen acne by raising hormones like cortisol, which increases oil production and inflammation. Poor sleep also disrupts hormone levels and weakens the body’s ability to heal, worsening breakouts.
The following habits can lead to better overall health and may promote clearer skin:
- Sleep 7-9 hours each night
- Get 150 minutes of moderate aerobic exercises each week
- Manage stress through deep breathing, yoga, or hobbies
- Walk 10,000 steps a day (work up to this if necessary)
PCOS can cause more than acne. Common symptoms include irregular periods, weight gain, extra hair growth, and emotional challenges. Addressing your PCOS symptoms can improve your quality of life and help prevent complications.
Irregular Periods and Ovarian Cysts
Hormonal birth control pills like Yaz (drospirenone/ethinylestradiol) help regulate periods, reduce pain, and prevent heavy bleeding. They also stop ovulation, lowering the risk of ovarian cysts.
Insulin Resistance and Weight Gain
Regulating insulin resistance and weight can help balance hormones and reduce PCOS symptoms. For people who are overweight, studies show losing a small amount of body weight (5–10%) can regulate periods, lower cholesterol, and reduce excess hair and acne.
Medications like metformin can lower insulin resistance. For people with diabetes or difficulty losing weight, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may help control blood sugar and support weight loss.
While this is not a complete list, some GLP-1 medications include:
- Ozempic (semaglutide)
- Saxenda (liraglutide)
- Victoza (liraglutide)
Other weight loss medications include Xenical (orlistat) or Contrave (bupropion/naltrexone).
Balding
Hormonal imbalances from PCOS may lead to hair loss. Rogaine (minoxidil) promotes hair growth by increasing blood flow to hair follicles. Birth control pills or antiandrogens can help slow androgen-related hair loss.
Hirtuism
PCOS hormonal imbalances can also lead to excess hair growth, typically on the body. Temporary hair removal options include shaving, waxing, threading, or plucking. For longer-lasting results, try laser hair removal or electrolysis.
Medications like antiandrogens or topical Vaniqa (eflornithine) cream can also slow hair growth.
Infertility
Maintaining a healthy weight and managing insulin resistance can improve fertility. Medications like Clomid (clomiphene) stimulate ovulation, helping release eggs and increasing the chances of conception.
Anxiety and Depression
Therapy, support groups, or medications like Prozac (fluoxetine) or Zoloft (sertraline) can help with mood, anxiety, and depression. Exercise, yoga, and relaxation techniques can also boost emotional and mental well-being.
Supplements like inositol improve insulin sensitivity and regulate cycles, while vitex (chasteberry) helps balance hormones for ovulation. Licorice root may lower androgens, and maca root can reduce stress and boost energy.
Always talk to your healthcare provider before starting supplements.
Hormonal imbalances, specifically high androgen levels, cause PCOS acne by increasing oil production in the skin. This acne often appears on the lower face and tends to be severe and persistent.
A provider may review your symptoms and order blood tests to diagnose PCOS acne. Treatment options include topical medications, antibiotics, birth control pills, or antiandrogens.
Combining these treatments with lifestyle changes, such as eating a nutritious diet and managing stress, can help improve acne. Hormonal therapies can also help reduce additional PCOS symptoms like irregular periods.
