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PCOS and Acne

Acne is a common symptom of polycystic ovary syndrome. It is an inflammatory skin disorder that involves interactions between hormones, hair, sebaceous or oil-secreting glands and bacteria.

Women with PCOS are susceptible to acne, possibly because of the excess levels of androgens or the male sex hormones in the skin. Teenagers are also susceptible around the onset of puberty due to an increase in the production of androgens. This androgen is a metabolite of testosterone and is also called as DHT.

It is thought that DHT stimulates the production of oil, which eventually leads to clogged glands or pores. Clogged pores cannot release oil and this allows the bacteria to grow and multiply in the follicle thereby leading to an inflammation.

Enzymes from this type of bacteria breakdown the triglycerides in the sebum (oil) to form "free fatty acids" that further irritate the follicular wall. Rupture of the follicle which is accompanied by the release of free fatty acids, bacterial products and keratin results in an abscess that heals with scars in severe cases.

What Causes Acne ?

  • Hormonal imbalance or hyperinsulinism which is common in PCOS patients.
  • Diet which is high in refined, high-glycemic carbohydrates that increase insulin levels.
  • Heredity or genetic predisposition to PCOS.
  • Medications- anabolic steroids, anti-epileptics, lithium and some oral contraceptives.
  • Industrial pollutants - petrochemicals such as machine oils, coal tar derivatives, chlorinated hydrocarbons, etc.
  • Cosmetics.
  • Over-washing or repeated rubbing of the skin.
  • Hormonal imbalances like increased progesterone secretion prior to menstruation.
  • Allergic reactions to foods.

Symptoms of Acne

  • Persistent, recurrent red spots or swellings on the skin. These spots or swellings usually occur on the face, but may also be found on the back, shoulders, chest, and neck.
  • Bulging spots under the skin with closed pores or more commonly known as whiteheads.
  • Heredity or genetic predisposition to PCOS.
  • Dark pimples under the skin with open pores also known as blackheads.
  • Presence of fluid-filled lumps known as nodules and cysts which may become abscesses.
  • Scarring of the skin in severe cases.

Acne problem may worsen during the winter months and improve in summer due to the beneficial effects of the sun.

Acne and PCOS Diagnosis

Diagnosis of PCOS is based on the presence of comedones or pimples and lesions at various stages of development. In case the acne is left untreated, it can also lead to both scarring and abnormal pigmentation.

Acne can be caused or exacerbated by elevated androgen levels. Androgen disturbances should be suspected when female adolescents have severe acne or when it persists into adult years, particularly when this is accompanied by other androgen-related effects such as hirsutism, infertility and weight problems.

If you have acne, the following tests will prove to be helpful in diagnosing the cause of your problems:

  • Serum levels of testosterone.
  • DHEAS, LH, FSH
  • Prolactin.
  • Cholesterol triglycerides and thyroid hormones.
  • A two-hour glucose tolerance test with accompanying insulin levels should also be done.

Many PCOS women will have abnormal levels of one or more of these tests, although the normal values do not rule out a PCOS diagnosis. Once your hormone imbalances are identified, the appropriate treatment can be recommended.

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