PCOS and Acne - A Hormonal Connection

Introduction

Acne is a skin condition in which the pores of the skin get clogged. Pore blockages can cause whiteheads, blackheads, and other forms of pimples. However, getting acne long after the teenage years may indicate something beyond facial blemishes, as it can be the symptom of an underlying hormonal disorder. Polycystic ovary syndrome (PCOS) is one of the most common hormonal disorders in women of reproductive age. Apart from affecting a woman’s fertility, polycystic ovary syndrome can give rise to various hormone-related side effects including acne.

What Is Polycystic Ovary Syndrome (PCOS)?

Polycystic ovary syndrome is a health problem seen in women due to the imbalance of reproductive hormones. The hormonal imbalance cause problems in the ovaries leading to abnormal production of male sex hormones called androgens, which are usually present in small amounts in women. These androgens are responsible for problems like hair loss, skin darkening, hirsutism (a condition in women characterized by excessive growth of coarse hair in the face, back, and chest in a male pattern), and acne. The ovaries normally produce eggs that are released every month during the menstrual cycle. However, with PCOS, the eggs are either not developed or released during ovulation as they should be.

How Does Polycystic Ovary Syndrome Cause Acne?

Acne is formed when dead skin cells and an oily substance called sebum build up inside the hair follicles, causing bacteria to get trapped beneath the skin. This gives rise to inflammation leading to formation of pimples. One of the significant features of PCOS is the excess production of male hormones called androgens which are known as hyperandrogenism. These androgens play an important role in the formation of acne. They make the glands in the skin produce excessive amounts of sebum.

Generally, the body produces the right amounts of progesterone, estrogen, and testosterone, depending on the signals received from the pituitary gland. These signals are disturbed in women with polycystic ovary syndrome leading to an increase in the levels of testosterone and a decrease in the levels of estrogen and progesterone. This can lead to anovulation and result in:

• Irregular periods.

• Hair growth on the face

• Acne formation.

Women with PCOS can develop acne in the following areas of the body:

• Face.

• Neck.

• Upper back.

• Chest.

What Are the Significant Features of Acne Related to Polycystic Ovary Syndrome?

• Acne is commonly seen in both males and females during their teenage years. But acne seen persistently in women above the age of 25 years can be PCOS-related acne.

• PCOS-related acne has usually been noted to flare up in areas considered to be “hormonally sensitive, " mainly the lower third of the face. These areas include

  1. Cheeks.

  2. Chin.

  3. Jawline.

  4. Upper neck.

• PCOS acne is characterized by more tender knots under the skin, unlike the surface bumps seen in regular acne.

• PCOS acne tends to flare up before menstrual periods and takes more than the normal time to resolve than normal acne.

• Acne in the hormone-sensitive regions of the face accompanied by consistently irregular periods can be a sign of PCOS-related acne.

When Do Polycystic Ovary Syndrome-Related Acne Flare Up?

Polycystic ovary syndrome-related acne flare up are affected by factors like:

• Diet.

• Lifestyle.

• Skin care products.

• Stress.

• Certain medications can cause acne to flare up.

However, in people with acne related to hormonal causes like PCOS, flare-ups are seen during the premenstrual part of the menstrual cycle. Some studies suggest that products like face serums and certain makeup products can also cause flare-ups. However, these are very rare and less consistent.

Do Dietary Factors Influence Polycystic Ovary Syndrome-Related Acne?

Even though dietary factors can affect acne, some research suggests that junk foods cannot lead to acne on their own. Certain foods can cause inflammation in the body which, when combined with risk factors like PCOS, can lead to acne. Red meat, white bread, sugary desserts, and white potatoes are a few examples of foods that cause inflammation.

What Are the Long-Term Health Risks of Polycystic Ovary Syndrome?

• Infertility.

• Diabetes.

• Cardiovascular risks.

• Obstructive sleep apnea.

• Endometrial cancer.

• Metabolic syndrome.

• Nonalcoholic fatty liver disease.

• Mood disorders like depression or anxiety.

How to Diagnose Polycystic Ovary Syndrome?

The tests to diagnose polycystic ovary syndrome are as follows:

• Pelvic Examination: Reproductive organs are checked for any growths, masses, or other changes.

• Ultrasound: Helps in detecting the enlargement of ovaries and the presence of cysts (partly developed eggs) in the ovaries. It is also useful in assessing the thickness of the uterine lining. Both transvaginal and abdominal ultrasounds may be performed.

• Blood Tests: Blood tests are done to measure the levels of hormones. Blood tests for free androgen index (FAI) and testosterone are useful in diagnosing hyperandrogenism (high androgen levels). Levels of other reproductive hormones like estrogen, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) are also assessed.

The criteria for diagnosing PCOS is that at least two of the following conditions should be met:

• Increased levels of androgen in the blood.

• Irregular or no periods.

• Polycystic ovaries (ovary enlargement or presence of follicles on the ovaries).

How to Treat Acne Caused by Polycystic Ovary Syndrome?

The measures to treat PCOS-related acne are as follows:

• Over-The-Counter (OTC) Acne Medications: OTC acne medications like salicylic acid, sulfur, and benzoyl peroxide help in treating acne. However, these medications can only reduce mild breakouts and do not show many results in hormonal acne.

• Oral Contraceptives: Certain oral contraceptive pills can treat acne caused by PCOS. The combination of progesterone and estrogen in these pills help in reducing testosterone levels which in turn limits the formation of acne. Combination pills that contain Cyproterone acetate and Drospirenone are very effective in blocking the effects of androgen.

• Anti-androgen Drugs: Spironolactone and Flutamide have shown good results in treating hormonal acne caused due to high levels of androgen.

• Retinoids: OTC retinoids are not of much use in PCOS- related acne. Prescription-strength options under the guidance of a dermatologist that can be either consumed or applied as a cream help with PCOS-related acne. Accutane is one of the commonly used options.

Conclusion

Often people experience low self-esteem or feel embarrassed due to PCOS symptoms like acne, hair loss, and excess facial hair. Apart from the symptoms which affect the external appearance, PCOS can lead to a lot of serious health issues. Hence, consulting a doctor and determining the cause of acne at the earliest is important to diagnose PCOS and provide effective treatment.