Acne and PCOS

Did you know that 1 out of 3 women with PCOS actually suffer from acne. I was one of these women myself – I developed acne when I was 19 and it took me 6 years to finally get to the root cause and clear it. I developed cystic acne which was extremely painful. In actual fact acne and PCOS are highly linked due to one of the root causes of PCOS which is high androgens.

I remember visiting my dermatologist who decided it was hormone related without even doing any blood tests and put me on birth control (something I completely disagree with as a healthcare professional myself now! Unfortunately I did not know any better back then!)

I had a very bad reaction to the birth control pill he put me on and ended up getting blood tests anyway. Which is when we discovered my high androgen levels and very high insulin levels.

PCOS Acne: Prescription Drugs

As a pharmacist I can tell you there are many drugs you can take for acne ranging from hormonal birth control, to antibiotic tablets, antibiotic creams. When these fail doctors will turn to Spironolactone which is a diuretic and has anti androgen effects or isotretinoin (marketed as Accutane). The problem with these treatments is that they don’t really solve the root cause of the acne and PCOS.

I can tell you that throughout my 6 year battle with acne I tried every medication possible.

Although I did see PCOS acne improvements from the pill, antibiotics, and spironolactone. My acne always rebounded and I ended up with even more pimples than when I started. These medications don’t decrease testosterone levels, they just mask its effects. When you stop taking the drugs then your testosterone levels will be just as high as they were before and your acne will return. So after many years of trying everything under the sun my dermatologist recommended Isotretinoin.

Accutane for PCOS Acne

This medication works by altering gene expresseion. I took isotretinoin for over 13 months but I must say I had some very very severe side effects These include:

  • Haemorrhoids
  • Dry, peeling, flaking, and itchy skin.
  • Dry eyes, mouth, and nose.
  • Infections in my nose and mouth due to the dryness
  • broken and bleeding lips
  • severe nose bleeds
  • Photosensitivity.
  • Joint pain.
  • Inflammatory bowel diseases
  • Increase in suicidal feelings.

Eventually isotretinoin did help my acne for quite some time but still the root causes where still there and I ended up getting acne on my back and chest in the following years.

The Root Cause of PCOS Acne

To fully comprehend the relationship between acne and PCOS we first need to look at the formation of PCOS acne:

  1. In PCOS the ovaries produce excess androgens. Furthermore 95% of women with PCOS also have some degree of insulin resistance
  2. Testosterone, DHEA-S (androgens) and insulin, stimulate the glands in the skin to overproduce oil.
  3. Pores get easily clogged and oil is trapped inside them. Bacteria then grows in these pores, causing inflammation to form around them. Antibiotics are often prescribed for acne because they kill this bacteria.
  4. The immune system detects a foreign object (bacteria) and activates the inflammatory system to fight the bacteria. This causes swelling, redness, and pustule formation as the immune system tries to force the bacteria to the surface.

Androgens are the root cause of PCOS acne problem. You need tackle the root cause of PCOS acne to treat it effectively. In my course PCOS blue print I deal with how to reverse root causes in detail

Insulin Resistance

Women with PCOS generally do not respond to insulin well and end up with very high levels of insulin. High levels of insulin stimulate the ovaries to overproduce testosterone. This results in more oil formation and then acne.

Inflammation and Poor Gut Health

Another root cause of PCOS is inflammation. Most women with PCOS will find they have many effects of high levels of inflammation.

Inflammation is a normal feature of our immune system. However, our bodies are not designed for it to be turned on all the time. Inflammation not only causes insulin resistance (causing increased androgens), but also causes acne in it’s own right. One of the main factors that cause inflammation is poor gut health.

For many years researchers have known that skin health is influenced by our gut health. The theory is that too much bad bacteria in the gut causes long term inflammation and skin issues. In fact recent studies have shown that increased levels of bad bacteria, especially in the small intestine, lead to increased levels of inflammatory markers. Studies have also shown that inflammatory pathways are activated in acne patients.

In my experience with PCOS patients, I’ve never met a patient with PCOS that didn’t also have disrupted gut flora.

Treating the Root Cause of PCOS Acne: Inflammation and Insulin Resistance

I’ve explained the root causes of PCOS acne: excess androgens caused by inflammation and insulin resistance. But to help fix your PCOS acne, you need to treat inflammation and insulin resistance. Here’s how:

Reduce sugar

Eating less sugar is one of the best things that you can do to reverse insulin resistance and inflammation, and therefore fix acne. Sugar causes insulin spikes and makes pre-existing insulin resistance even worse. Bad bacteria also feed off sugar, which increases inflammation.


Avoid Dairy especially skimmed milk products

Milk consumption results in significant increases in insulin and insulin-like growth factor, IGF-1. Correlational studies that have looked at populations that don’t consume dairy have suggested that dairy may play a part in acne development. I’ve certainly seen improvements in PCOS acne in many of my patients when they’ve removed dairy from their diets. Removing dairy reduced their acne significantly.

For those who consume skimmed and low fat dairy acne generally tends to be worse as when removing the fat from the milk you also remove the fat soluble hormones found in milk and leave milk which is very high in testosterone thereby reinforcing the negative effects of testosterone.

Take Supplements

Some of the best supplements for PCOS acne include:

  • Zinc: Zinc is like a miracle nutrient for PCOS acne. It reduces androgen levels, is an anti-microbial, therefore killing bacteria, and reduces inflammation. Zinc acts on all three steps of the acne pathway.
  • Inositol: Inositol is a B vitamin that is crucial in the glucose metabolism pathway. Studies have shown that women with PCOS may have a defect in the way inositol acts in the body. Inositol is also essential at helping with glucose metabolism and reduction of insulin resistance.

Heal Your Gut

The aim of rebalancing your gut bacteria (microbiome) is to increase the number of good bacteria and reduce the number of bad.

A diet high in fibre and probiotics will help get you on the right track. You can get probiotics by taking a good quality supplement and eating fermented food. I would encourage you to introduce fermented foods into every meal. They significantly reduce the breakdown of carbohydrates, which reduces blood sugar.

If you would like to learn more about your PCOS my 10 week course will help you learn more about PCOS and treating root causes. Book a free consultation if you would like to know more.