The skin PCOS symptoms of oily skin, hormonal acne, and hirsutism can be some of the most daunting aspects of living with PCOS. There are evidence based ways to effectively approach PCOS skincare to help resolve these symptoms, which is what I'll be sharing with you in this article.
The same hormonal disorders that cause symptoms like irregular menstrual cycles, weight gain, and infertility for people with PCOS also cause skin problems, and figuring out what does and doesn't work can be incredibly frustrating.
Skin health takes a comprehensive approach that includes a variety of lifestyle factors, from diet to skincare (and sometimes medication). Finding what works for you can take time, but you have options.
Introduction to PCOS and Skincare
When you think about PCOS and how it affects your skin, it's helpful to understand why the condition impacts the skin for so many people.
Understanding PCOS
Polycystic ovary syndrome (PCOS) is a complex metabolic and endocrine (hormone) health condition that impacts up to 10 percent of women of reproductive age. High androgens—like testosterone, dihydrotestosterone (DHT), and DHEA—that contribute to symptoms like irregular periods, weight gain, hair loss, infertility, and skin issues. Elevated levels of androgens lead to skin PCOS symptoms like acne, cystic acne, and hirsutism, which is course, thick, and dark hair growth on the face or body.
In as many as 70% of cases, PCOS is also accompanied by insulin resistance. Insulin resistance means the body doesn't respond to insulin as it should, so blood sugar (and insulin levels) remain high. Insulin also can lead to excess androgens produced by the ovaries, so the two go hand-in-hand with PCOS, and both can cause problems with your skin.
How PCOS Impacts Skin Health
I'll share the specific mechanisms and ways PCOS skin conditions happen below, but as an overview, when hormone levels are imbalance and androgen excess is present, cystic acne, oily skin, and excessive hair growth can develop. Coarse hairs on the chin, chest, or abdomen are a hallmark sign of excess androgens.
One study found that 78% of those living with PCOS and elevated androgens experienced excess hair growth on their face or body, and almost 50% had hormonal acne, showing the close tie between hormones and your skin.
Insulin resistance and high blood sugar levels can also cause skin tags and skin darkening, known as acanthosis nigricans.
To adequately address testosterone levels and insulin, healthy blood sugar levels must be a focus of treatment. We'll discuss this in addition to other acne treatment areas to focus on in resolving PCOS skin issues.
Skin Problems Associated with PCOS
The following are the most common skin problems associated with PCOS that I see in my practice:
Acne and PCOS
There are 5 key mechanisms that lead to acne vulgaris or hormonal acne:
- Increased sebum production
- altered lipid composition
- Increased keratin production
- Bacterial overgrowth, most commonly from Propionibacterium acnes (P. acne)
- Skin inflammation
The causes of PCOS acne are multifaceted, but generally, it stems from an overproduction of sebum, the waxy, fatty substance produced by cells in the skin called sebocytes. Sebum has antimicrobial and anti-inflammatory properties to protect the skin, but in excess, it can clog your pores and cause inflammation (which also contributes to acne).
Where does PCOS fit in here? High androgens can increase sebum production, which creates acne prone skin. It also can lead to increased keratin production that clogs pores.
Because PCOS has an inflammatory component, it may already set the stage of inflammation of the skin when coupled with the androgen driven changes. This is why an anti-inflammatory diet and the use of anti-inflammatories in the management of PCOS is so important.
Long-term skin problems can lead to anxiety and depression (and people with PCOS are already at higher risk for mental health conditions), but I want you to remember that it's treatable.
Hyperpigmentation in PCOS
Hyperpigmentation, another PCOS skin condition, is the darkening of the skin, which can be caused by sun exposure or hormone imbalances. Excess androgenic hormones in PCOS can lead to increased production of melanin (which gives our skin its color), resulting in darker patches on the face, neck, chest, and other body parts.
Acanthosis nigricans, which is closely tied to high blood sugar and insulin resistance, is also associated with PCOS and can lead to dark skin patches in the neck, groin, or armpits. This dark skin has a velvety texture. This is another reason why maintaining healthy blood sugar levels are so important in PCOS skincare.
If you're noticing an uneven skin tone, it's important to meet with your provider.
Increased Hair Growth Due to PCOS
Unwanted hair growth—called hirsutism— is a challenging skin PCOS symptom. Women with PCOS often experience excessive hair growth on their face, chest, stomach, and back.
Hirsutism is closely connected to elevated testosterone and dihydrotestosterone (DHT), an active androgen. Androgens can stimulate hair growth and cause hair to grow thicker and darker.
Let me be clear that the unwanted body hair isn't culturally related, as some people mistakenly believe. This type of hair growth is course, thick, dark, and follows the typical androgen distribution.
It's also important to note that the same hormones that cause unwanted hair growth on the body can also lead to hair loss on the scalp.
Skin Tags and PCOS
Skin tags, also known as acrochordons, are another skin manifestation that women with PCOS may encounter. They are small, soft growths on the skin surface. Commonly found in areas with skin folds such as the neck, armpit, and groin, skin tags are not harmful but can be a cosmetic concern for many. The link between PCOS and skin tags lies in insulin resistance, which may trigger skin cell growth.
Reasons for Skin Problems in PCOS
Hormone imbalance is the primary reason behind skin problems with PCOS, so let's examine how this happens.
Hormonal Imbalance in PCOS
As you learned above, the imbalance of high androgens triggers a cascade of symptoms in PCOS, like sebum with acne, cystic acne, or skin discoloration. However, elevated androgens and insulin resistance also connect to increased inflammation—another essential connection to the skin manifestations in PCOS.
Research suggests that inflammatory immune cells such as tumor necrosis factor-alpha (TNFα), interleukin-6 (IL-6), interleukin-18 (IL-18), and C-reactive protein (CRP) have been associated with PCOS and may be stimulated by androgens. These proteins are released as part of the inflammatory response to act as signaling molecules. And these same proteins are also connected to inflammatory skin conditions like PCOS acne.
It is important to note that while birth control pills are often prescribed for the management of PCOS, they only address the androgen issue, not the inflammation or insulin resistance.
Insulin Resistance and Skin Health
Aside from increasing androgen and sebum production, insulin resistance impacts skin health in other ways as well. Too much insulin in your bloodstream can increase skin cell production rate, resulting in darker patches of skin. Insulin resistance can also increase the levels of a hormone called insulin-like growth factor-1 (IGF-1), which promotes cell growth and prevents cell death. This further contributes to the production of skin cells that can cause skin tags and the resulting skin discoloration.
Research has shown that omega-3 fatty acids for oily fish is associated with more favorable levels of IGF-1 and less acne. This is one of the reasons including a high quality fish oil, like Omega Plus, can be helpful part of your PCOS skincare routine.
Prevention and Management of Skin Problems in PCOS
There's never just one solution to any skin issue, and the best way to manage your PCOS-related skin problems is by following a holistic approach. This means addressing PCOS simultaneously through lifestyle modifications such as exercising more, improving nutrition, and reducing stress. It also means using natural remedies in combination with conventional medications when needed.
Please remember that this content is not a substitute for medical advice. Please always discuss any treatment with your provider.
Importance of Regular Skincare Routine
Let's start with the basics. If you're dealing with acne, no more skipping that evening face wash or forgoing moisturizer! Treat your skin with the care that it deserves. That means creating a routine each morning and night to cleanse, hydrate, and nourish your skin. This will help regulate oil production, eliminate old skin cells and other debris from the environment, and support the healthy functioning of your skin's protective barrier.
While oily skin may make you feel like you need to dry it out, dry skin can actually make acne worse in some cases.
Your skincare routine should also include non-topical support like nutrition or supplements. Think of it as an inside-out approach to your skin health.
Natural Remedies for Skin Problems in PCOS
Addressing the foundations of hormone balance and insulin resistance is essential for the long-term healing of PCOS-related skin issues. There are several natural remedies and supplements to consider that are especially beneficial (and you can read all about my supplement recommendations for PCOS here):
Saw Palmetto:
Saw palmetto is a botanical that supports healthy hormone levels by assisting the body in balancing androgens. Saw palmetto may even help by inhibiting the ability of the body's tissues to absorb or use androgens.
Inositol:
If I had to choose only one supplement for PCOS, it would probably be inositol. Inositol, also known as vitamin B8 (although it's not technically a vitamin since the body can produce it), is found in tissues all over your body. It plays a crucial role in cell signaling and is involved in many cellular and reproductive processes, from glucose metabolism and insulin sensitivity to egg maturation.
Think of inositol as a bridge for your hormones, helping to relay the message inside, making your cells better at responding to insulin to improve blood sugar balance. Studies suggest that supplementing with inositol can help with insulin and androgen levels to reduce acne and hirsutism.The ideal for PCOS is to have a balance of myo inositol and D-chiro inositol in a ratio of 40:1. In addition, nutrients like chromium have been shown to assist in blood sugar balance, while green tea extract may help with hair loss. This is why we combined the ideal levels of inositol with nutrients specific to a PCOS patient's needs in our Myoinositol Plus.
Vitex or Chaste Tree Berry:
According to research, vitex may help the underlying hormone imbalances in PCOS by supporting healthy progesterone levels and balancing testosterone. Vitex plays a key role in Balance—Women's Hormone Support by Dr. Brighten, crafted to tackle hormone issues by combining B Vitamins, antioxidants, and hormone-supporting herbs.
N-Acetyl Cysteine (NAC):
N-acetyl-cysteine (NAC) is an essential antioxidant and amino acid for hormone balance. A study on supplementing with NAC revealed it supports reductions in hirsutism, fasting insulin, and free testosterone.
Lifestyle Changes to Improve PCOS Skin Issues
Daily habits can significantly impact hormone balance and blood sugar, and I could write multiple articles about each (and I have many you can read). That said, I can't not mention them here because they are so crucial in building the foundation for healthy skin. Nutrition and movement are also so critical that they are now considered the first line of treatment for PCOS.
Exercise and Impact on Hormonal Balance
Exercise (even walking after a meal) improves insulin sensitivity, making cells more likely to respond to insulin. Strength training also enhances lean body mass, which can positively impact metabolism, and some studies suggest that resistance training can help lower androgens.
Exercise also benefits mood, stress, and sleep, promoting overall wellness. Balancing higher intensity (if it works with your body), strength training, yoga, pilates, or other low-intensity cardio can all benefit your skin and well-being.
Diet Changes for Better Skin Health in PCOS
The most essential diet change to make for PCOS skin problems is eating for blood sugar balance. Insulin levels and hormones like testosterone are supported when blood sugar is balanced.
What does eating for better blood sugar look like?
- Eat a protein packed breakfast (best breakfast foods for hormones found here)
- Fill up on fiber and protein.
- Choose complex carbohydrates like sweet potatoes and oats over refined carbs like white bread and sugary treats.
- Include healthy fats like avocado, olive oil, and nuts.
- Limit processed foods.
- Eat more green leafy vegetables.
These dietary changes can also help to reduce inflammation in your body. My free Hormone Balancing Recipe Guide gives you a 7-day meal plan with recipes to get you started.
Professional Skincare Treatments for PCOS
Even with natural support, you might still want a bit of extra help while working on your hormone balance to support your skin goals. An analysis from a dermatologist who can properly assess your skin is a good place to start.
Dermatological Treatments for PCOS-Related Acne
A dermatologist may suggest a range of options depending on your skin goals. Typical treatments start with topical options you put directly onto your skin, like benzoyl peroxide, retinals, or azaleic acid.
If acne is more severe, your health care provider may suggest antibiotics or even birth control pills that impact how your body makes hormones. Oral contraceptive pills can lower androgen production and increase sex hormone binding globulin (SHBG), which will also lower testosterone. If you chose to use birth control pills, keep in mind that acne will likely return when you discontinue. You can read more about acne after stopping the pill here.
Sometimes, prescription medications that directly lower androgens, like Spironolactone, are used if acne is severe and not responding to other treatments.
Ultimately, it's your choice to take medications for support. I never want anyone to feel shame if they go this route. I encourage you to make sure you have true informed consent when taking any of these medications, meaning you understand all the benefits and side effects of your course of treatment.
Working through lifestyle, diet, and supplements (with the okay from your doctor) while on medications may help you achieve even better results, so eventually, you aren't reliant on prescriptions anymore.
Laser Treatment for Excessive Hair Growth
Some women choose laser hair removal if there is a lot of facial hair growth. While not permanent removal, hair grows back much more slowly than shaving, so you have more time between treatments. Depending on your skin and hair type, studies suggest hair reduction can range from 10% to 90%, and these results may last up to 12 months.
PCOS Skincare Products
It can take trial and error to find the right products for your skincare routine, but there are some general tips for anyone with PCOS-related skin issues.
Best Moisturizers for PCOS Skin
Look for moisturizers that are non-comedogenic and hypoallergenic. Natural ingredients like green tea extract, rosemary leaf oil, and aloe vera can help reduce inflammation while nourishing the skin. It may feel counterintuitive because we associate “oily” skin with acne, but keeping your skin moist with natural oils like jojoba, coconut oil, and argan oil is great for calming inflammation and reducing acne.
Topical Treatments for Acne
There are many over-the-counter topical treatments to help with acne. Look for products that contain ingredients like salicylic acid, benzoyl peroxide, glycolic acid, and sulfur, which all help reduce inflammation and unclog pores. It's important to start gradually and build up the concentration of the active ingredients to prevent further irritation, so consider trying every other night or every third night to minimize the risk of over-treating the skin.
Exfoliants
Some of the topical treatments above are technically exfoliants because they help to remove dead skin cells, but you can also use physical exfoliants like facial scrubs or brushes.
Exfoliating helps to reduce the build-up of dirt and oil on the skin, which can contribute to breakouts. Still, too much exfoliating can damage your skin barrier and contribute to inflammation and breakouts. So, your best may be to use a gentle washcloth with your cleanser and stick to topical treatments.
Conclusion: Integrating PCOS Care and Skincare
Skincare can be considered the finishing touch if you think of hormone balance as the foundation for your PCOS care. It's tempting to only focus on the quick fixes, but if you want to look—and more importantly feel—your best, focusing on hormone and blood sugar balance is a must.
Making a Skincare Plan when Living with PCOS
When you practice holistic skincare and commit to diet and lifestyle changes tailored to your unique needs, you create a balanced internal environment that helps with overall skin health. Implementing these strategies can help reduce the visible signs of PCOS from the inside out. Sometimes, medications can help with symptom management, which should be discussed with your healthcare provider.
Addressing PCOS-related skin challenges might seem daunting, but radiant skin is attainable with a dedicated skincare routine and the right plan for your body.
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