PCOS and Acne

Polycystic Ovarian Syndrome (PCOS) affects about 10% of reproductive age women. PCOS is an endocrine disorder that can affect reproductive hormones and the metabolic system in the body. That being said, PCOS results in a hormonal imbalance caused by the disconnection between the brain and the ovaries. The pituitary gland in the brain sends signals to the ovaries to produce estrogen, progesterone, and testosterone. PCOS often disrupts this connection and can cause estrogen and progesterone to drop resulting in higher levels of testosterone.

Acne is one of the biggest symptoms in PCOS that women often struggle with. It causes a lack of self-esteem and confidence especially when it becomes difficult to manage. In women with PCOS, acne is commonly found on the jawline, chest, and back. The acne that presents is characterized by deep cystic lesions that are often painful.

Causes of PCOS Acne

Acne can be caused by a variety of different factors such as excess oil production, bacterial growth, (Propionibacterium acnes) and hormonal imbalances. PCOS acne is driven by hormonal imbalances. Below are the most common imbalances we see with PCOS resulting in acne:

1. Testosterone is often elevated in women with PCOS which can cause the sebaceous glands to produce too much sebum causing acne lesions. This type of acne is usually found on the jawline, chest and back.
2. Insulin Resistance can cause high levels of insulin to be circulating in the blood. Insulin can drive testosterone production, which in turn, can cause acne.

Other Causes of Acne

Acne can also be driven by food sensitivities, inflammation, stress, not washing your face regularly, dehydration, and certain makeup products.

PMS and Acne

You may notice that your acne gets better during the middle of your cycle (or around ovulation) and gets worse right before your period. This has to do with estrogen and progesterone. Both estrogen and progesterone reduce the production of sebum. Around the time of ovulation, estrogen is at its’ peak which is why your skin can be clear. Estrogen and progesterone both decline right before your period which is why acne can get worse. Working on supporting estrogen and progesterone levels can be helpful, however dealing with the causes should be the first approach.

Conventional Strategies: 

1. Birth control: Often times acne is treated using the birth control pill. The birth control can work very well at controlling acne since the synthetic estrogen it contains helps to suppress sebum/oil production. However, your skin can become reliant on this form of estrogen and once removed your acne can come back worse than when it first started.
2. Spironolactone
3. Accutane

Naturopathic Strategies: 

1. BOTANICALS can help to reduce testosterone levels. Anti-androgenic herbs include Serenoa rapens, Spearmint, Glycyrrhiza glabra, white peony, and Ganoderma lucidum. Check out this article on how to reduce testosterone levels.  
2. DIET: Optimizing your diet to reduce testosterone can be extremely beneficial. Dairy products and sugar are among the biggest culprits that can affect acne. Dairy is considered low on the glycemic index but very high on the insulin index. Therefore, it can raise insulin levels and ultimately raise testosterone. Sugar is very inflammatory to the body. It can also impact the balance between insulin and glucose. Removing sugar altogether can make a significant impact on reducing the frequency of acne lesions. To learn more about how to eat for PCOS check out this article.
3. SUPPLEMENTATION: One of the best supplements for acne associated with PCOS is N-acetyl-cysteine (NAC). NAC is a very potent antioxidant that can be very beneficial in PCOS as well. It is a precursor to one of the biggest antioxidants in our body called glutathione. NAC is shown to reduce inflammatory acne lesions. Additionally, NAC can help to reduce testosterone levels, improve insulin sensitivity and ovulation in women with PCOS.

Other supplements to consider are zinc, berberine, omega 3, vitamin D and probiotics.

References: 

Hamid Al-Anbari Karbala, H., Hamid Al-Anbari, H., Abu-Raghif, A. R., & Sahib, A. S. (2012). The Antioxidant effect of N-Acetylcysteine and its…. The Antioxidant Effect of N-Acetylcysteine and Its Role in the Treatment of Patients with Acne Vulgaris The Antioxidant effect of N-Acetylcysteine and its…. In J. Med (Vol. 5). Retrieved from https://www.iasj.net/iasj?func=fulltext&aId=78031

Östman, E. M., Liljeberg Elmståhl, H. G., & Björck, I. M. (2001). Inconsistency between glycemic and insulinemic responses to regular and fermented milk products. The American Journal of Clinical Nutrition, 74(1), 96–100. https://doi.org/10.1093/ajcn/74.1.96