PCOS (polycystic ovary syndrome) is a hormonal condition that causes a range of symptoms in women of reproductive age. Acne is one related condition affecting 30% of PCOS sufferers, which on top of other PCOS-related symptoms, adds to a feeling of anguish and low self-confidence.
PCOS-related acne has multiple causes, mainly powered by the high level of androgens in the body. With PCOS acne you are more likely to have cystic acne, which can appear as deep inflammatory pus-filled red spots on the lower half of the face, the so-called muzzle distribution. These are painful, take a while to resolve, and carry the risk of scarring.
Regular acne tends to sit more superficially on the skin as non-inflammatory whiteheads and blackheads, typically in the oily T-zone.
In PCOS the ovaries produce more of a group of hormones called androgens, including testosterone. Androgens cause the glands in the skin to produce sebum, an oily substance. When sebum is trapped under the skin alongside other dead skin cells and bacteria, it can lead to the formation of acne, commonly in the face, neck, shoulders and back.
PCOS can go hand-in-hand with insulin resistance, and PCOS acne can be sensitive to the high circulating sugar levels, alongside chronic inflammation, stress and bacterial infections.
To reduce the presence of acne, it is recommended that you cleanse the face twice daily with lukewarm water, and after excessive sweating. It is important to avoid using anything abrasive on your skin, such as scrubbing or using applicators and sponges, as this can cause more inflammation and sebum production. Make sure any moisturisers and make-up have a non-comedogenic label.
Avoid anything that will cause irritation like some perfumed products. Although tempting for some, spots should be left alone and not squeezed or popped as this further spreads bacteria around the face and worsens inflammation.
If acne is causing you distress and you’ve tried over-the-counter treatments, or you have inflammatory spots or signs of scarring, you should see your doctor.
They may offer certain creams, gels or lotions. They will often offer these in combination with certain antibiotics. These are chosen for their anti-inflammatory properties and offered on a long-term basis – it can take a few months to see an effect.
As androgens like testosterone are increased in PCOS, oral contraceptives are an effective method for reducing acne as the combination of oestrogen and progesterone reduces testosterone levels.
Any combined hormonal contraceptive is more likely than not to have a positive effect, but some are better than others. Cyproterone acetate (brand name Dianette) and drospirenone (brand name Yasmin) have stronger anti-androgenic effects but carry a higher risk of blood clots, so they are not suitable for everyone. Speak to your doctor about starting an effective oral contraceptive.
If these possible treatments don't work or you can’t tolerate the side effects, your doctor may refer you to a specialist dermatologist to consider alternative medications such as tretinoin (brand name Roaccutane) or spironolactone.
Private dermatologists and aestheticians can consider chemical peels and laser therapies.
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