Polycystic Ovarian Syndrome (PCOS for short) is one of the most common hormonal conditions in young women [1]. Along with other symptoms such as irregular periods, hair loss on the head and hair growth where you don’t want it, PCOS acne is a frequent feature of the condition [2].

This article covers why PCOS acne happens and how you can distinguish it from other types of acne. Most importantly, we look at steps you can take to deal with PCOS acne naturally.

Contents

What is PCOS acne?
PCOS acne location
Treatment for PCOS acne
Natural approaches for PCOS acne
PCOS acne diet
PCOS acne supplements
PCOS acne skincare
One last thing…
Takeaway points

What is PCOS acne?

PCOS acne occurs due to out-of-balance hormones. This is worth understanding—because if you know what’s going on, you can work out how to fix it.

It all starts with the hormone insulin. Your pancreas releases insulin every time you eat, and its job is to get glucose out of your bloodstream and into your body cells. This process is a normal and healthy bodily function.

Enter PCOS. Up to 80% of women with PCOS have what’s known as insulin resistance [3, 4]. This means that their body cells don’t listen to insulin. Thinking that its message isn’t getting through, the pancreas keeps producing more and more insulin to compensate—kind of like a person shouting louder and louder.

Still with me? Great, as this is the key to unlocking the cause of PCOS acne.

So, you have lots of insulin hanging in your bloodstream. Hormones always like to get each other involved, so this insulin tells your body to produce more testosterone and other androgen hormones too [5].

And here’s the crucial bit: testosterone loves to talk to your sebaceous glands. It whispers to them, telling them to ramp up sebum production and start shedding cells at an irregular rate [6].

The result? Blocked pores and angry breakouts.

Treatment for PCOS acne

 Before we get on to some natural solutions, let’s look at the conventional treatments available for PCOS acne:

Oral contraceptive pills

These can suppress your body’s androgen production, meaning there’s less testosterone to fire up your sebaceous glands. These can work very well, but only while you’re taking them. Many women find their acne returns once they come off the pill [11].

Spironolactone

This is another type of medication that stops your body from responding to androgen hormones. Women who take spironolactone must also be on some form of birth control because there’s a risk it could prevent an unborn baby from developing properly [12].

Metformin

Remember how your body cells ignoring insulin kicks off the PCOS acne pathway? Metformin helps your body cells listen to insulin again. It can be very effective, though, like the contraceptive pill, it only works while you’re taking it [13]. Side effects of metformin include nausea, vomiting, abdominal pain and diarrhoea [1].

As you can see, these treatments work by intercepting the hormonal pathways involved in PCOS acne. The good news is that natural approaches can do the same thing [14]. In some instances, they can stop the pathways from developing altogether.

Please note: you must never stop a medication without first consulting your doctor.

Natural approaches for PCOS acne

Here’s what you’ve been waiting for: the diet, supplement and skincare tips for PCOS acne. The food and supplements work by balancing hormonal function on the inside, while the skincare halts the acne-driving processes on the skin.

Let’s take a closer look at each.

PCOS acne diet 

Well-designed studies have shown the eating a low-glycaemic diet can help to improve acne [15]. ‘Low glycaemic’ is just a fancy way of saying a diet that’s low in sugar but rich in fibre.

This approach to eating works because low-sugar, fibre-rich foods balance your blood sugar and keep your insulin in a healthy range. Remember, too much insulin is what starts the PCOS acne pathway!

A low-glycaemic diet doesn’t have to be complicated or restrictive. Simply reconsider eating anything that’s sweet, fluffy or white, and instead focus on satisfying wholegrains, lean proteins and colourful fruits and vegetables. For more tips on balancing your blood sugar, head to this article.

Eating in this way can also help you to reach a healthy weight. This is great news because sensible weight loss can reduce acne-driving androgens too [16].

As well as your general dietary pattern, specific foods are especially helpful at combatting PCOS acne:

Eat more: Flaxseed

One study showed that 12 weeks of flaxseed supplementation improved insulin resistance and reduced inflammation—which are both helpful for beating acne [17]. It has many other positive effects on your skin too. Try two tablespoons of flaxseed daily (freshly ground if possible). Stir into porridge, sprinkle on salads or swirl into soup.

Drink more: Spearmint tea

This humble tea is well-known for having anti-androgenic properties, and two studies have shown that drinking green tea can reduce testosterone levels [18, 19]. The best part? You don’t need to drink much. Just two cups of spearmint tea daily are enough to have an effect.

Eat more: Cinnamon

Studies show that this everyday spice can improve insulin sensitivity in women with PCOS [20, 21]. By now, you know that healthy insulin function is critical for clear skin! Aim for one teaspoon of cinnamon daily, sprinkled on foods or stirred into hot drinks.

So, you want to add in flaxseed and cinnamon and enjoy two cups of spearmint tea daily. But is there anything you should be cutting out?

Eat less: Dairy

There is a question mark over dairy. Certain forms of dairy can hike up insulin and start the acne-driving pathway [22]. Skimmed milk is the worst culprit, while other forms such as hard, aged cheese and yoghurt don’t seem so problematic [23].

It’s worth eliminating or reducing your dairy intake to see if it has an impact, but there’s no need to become obsessive about it. In practice, that means opting for dairy-free milk in your latte—but not stressing if you eat a dish that contains a little bit of butter. Your diet should always remain as diverse as possible.

PCOS acne supplements

For many, dietary tweaks are enough to promote clear skin. But for others, a few research-backed supplements can be an important piece of the PCOS acne puzzle.

Please note: if you’re currently taking any medication, or if you’re pregnant or breastfeeding, please consult your doctor before taking any supplements.

Myo-inositol

This is a natural substance that’s related to B vitamins. It acts as a sort of messenger in your body, helping your cells to interpret insulin’s messages.

Some evidence suggests that women with PCOS don’t have enough myo-inositol or can’t use it effectively—contributing to insulin resistance [24]. In these cases, supplementation can help.

Two studies have found that supplementing with myo-inositol (and a related form, d-chiro-inositol) can help to reduce PCOS acne [25, 26]. Look for a formulation that gives you 600mg–2g myo-inositol/d-chiro-inositol daily.

Probiotics

Lots of probiotic strains can help acne, but one study showed that Lactobacillus rhamnosus SP1 in particular improved skin appearance in 12 weeks, possibly through influencing insulin signalling [27].

This probiotic strain can be tricky to find in off-the-shelf probiotics. Fortunately, a more widely available strain—known as Lactobacillus acidophilus NCFM—works in a similar way [28]. You can find that strain here.

Omega-3 fats

Scientists aren’t exactly sure why this happens, but studies show that taking 4-6g omega-3 fats daily helps to reduce testosterone levels [29, 30]. Less testosterone = less sebum = less acne.

You can find omega-3 supplements derived from fish oil. If you prefer to eat a plant-based diet, you can also find supplements derived from marine algae. Whichever one you opt for, be sure to check they responsibly sourced and tested for purity.

You don’t need to take all of these supplements, and you shouldn’t need to take any supplement forever. Commit to three months to begin with, and then start to phase the supplement(s) out while monitoring your skin’s reaction.

PCOS acne skincare

 A gentle, pH-balanced routine is the foundation of calm and unreactive skin. Once you’ve got that nailed, try adding in some specific active ingredients:

1) Green tea extract

Remember how testosterone is involved in the PCOS acne pathway? Well, there’s another part to the story: an enzyme in your skin converts testosterone into an even stronger, acne-driving hormone known as DHT.

Green tea to the rescue! This contains a special compound which blocks this pesky enzyme and stops the conversion—making your skin less prone to breakouts [31].

Look out for Cameillia sinesis (green tea’s Latin name) on cosmetics ingredients labels. The higher Cameillia sinesis appears on the list, the higher the concentration of green tea extract in the product.

If you prefer a DIY approach, you can also use the homemade facemask below.

2. Antioxidants

Research suggests oxidation also plays a role in PCOS acne [32]. You can combat oxidation internally by eating lots of colourful fruits and vegetables. You can help to fight oxidation on the skin surface by applying antioxidants such as vitamin C, ferulic acid, lipoic acid and vitamin E.

Vitamin C in the form sodium ascorbyl phosphate has proved especially effective at fighting acne [33]. You can find a selection of serums containing sodium ascorbyl phosphate here.

One last thing…

Another curious research finding is that women with PCOS have higher concentrations of bisphenol-A (BPA) in their blood compared to women who don’t have PCOS [34]. BPA found in plastic water bottles, plastic food containers in the linings of some canned goods.

We can’t say for sure whether BPA contributes to acne and other PCOS symptoms. But we do know that BPA is an endocrine disruptor, which means it has the potential to throw off hormonal balance [35].

For the sake of your skin (and the planet), it’s worth cutting down on your use of plastic. Eat less food from packets, invest in a stainless steel water bottle and store leftover food in glass containers. Every little action helps.

Takeaway points

– PCOS acne occurs due to out-of-balance hormones. Excess insulin bumps up testosterone levels and other androgen hormones, which make your skin oilier and more acne-prone.

– PCOS acne typically appears on the lower face, although it can also crop up on the neck, chest and upper back.

– Conventional treatment for PCOS acne includes oral contraceptive pills, spironolactone and metformin. These work by intercepting the hormonal pathways involved in hormonal acne.

– Natural approaches for PCOS acne include:

– Eating a low-glycaemic diet

– Eating 2 tbsp ground flaxseed daily

– Drinking 2 cups of spearmint tea daily

– Eating 1 tsp cinnamon daily

– Reducing your intake of dairy

– PCOS acne supplements include:

– Myo-inositol

– Probiotics

– Fish oil

If you’re taking any medication, or if you’re pregnant or breastfeeding, you must consult your doctor before taking any supplements.

– Skincare ingredients that can be helpful for PCOS acne include green tea extract and antioxidants.

– Cutting down on your use of plastic may also help PCOS acne.

Want a done-for-you plan for creating clear skin? Get your copy of The Happy Skin Roadmap.

Fiona Lawson is a former national magazine editor turned registered nutritionist and skin specialist. She holds an MSc in Nutritional Medicine and a BANT-registered post-graduate qualification in Nutritional Therapy.