‘How I Cleared My Skin When I Learned PCOS Was Causing My Cystic Acne’
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Unless you’re biologically blessed, you probably (painfully) remember the physical and emotional uphill battle that was teenage acne. For me, I got the typical bumps along my T-zone from the age of 12. However, as my friends and I entered our mid to late teen years, their skin slowly started clearing up as mine worsened.
The small bumps on my forehead turned into large, painful, cystic acne along my jawline. It wasn’t until seeing about a dozen different gynecologists that one tested me for polycystic ovary syndrome, or PCOS, in my mid-twenties. She immediately diagnosed me with the hormonal disorder, which affects 10 percent of the population.
PCOS can create too-high levels of androgens, or hormones that help control processes like hair growth and muscle growth in the body (the most commonly known one is testosterone). When that happens, androgens can increase inflammation both in and outside of the body, which is what leads to cystic acne.
Now in my late twenties, I’ve finally found a routine that helps keep my PCOS acne at bay. As an Indian woman, it was important for me to work with doctors who were also Indian, or at least familiar with the differences in my skin and symptoms (some studies also suggest that PCOS symptoms affect South Asian patients more severely than white patients). So, I called on Felice Gersh, MD, award-winning OB-Gyn and author of the PCOS SOS series and Manjula Jegasothy, MD, board-certified dermatologist based in Miami. They both helped me along my PCOS acne journey, and now will help explain the connection between acne and PCOS, plus how to treat it, below.
PCOS patients have three triggers for cystic acne.
According to Dr. Gersh, those three things are high androgen levels, systemic inflammation, and an estradiol (a form of estrogen) deficiency. “Estradiol assists in the skin’s healing process and production of fatty acids on the skin that protect it from acne-causing irritations and pathogens,” says Dr. Gersh. So, when estradiol levels are low, the skin has trouble not only fighting off bacteria that causes acne, but healing from it. Because of that, cystic acne more easily forms and sticks around from month to month.
PCOS-induced acne needs to first be addressed hormonally.
Dr. Jegasothy says she is often the first person to spot PCOS in her patients who have complaints about their acne because that acne is particularly cystic and forms along the jawline, a hotspot for hormonal acne. “With my PCOS patients, they often don’t realize that their acne is primarily a gynecological, hormonal issue,” she says. But it's important to address the hormonal condition first. “They have to first treat their PCOS with gynecology and get that under control. Any acne treatments I do on the outside won’t work unless my patients are working on curing the root issue.” Because PCOS is such a chronic hormonal condition, the skin often won't respond to a quick fix. Doctors often recommend lifestyle changes like a cleaner diet and more exercise to treat the insulin resistance and weight gain that's sometimes associated with PCOS, or might advise other solutions to regulate the hormones, including hormonal birth control, progestin therapy via a progestin pill or IUD, or injections of other hormone medications.
There's a difference between a PCOS-induced breakout versus a standard breakout.
As someone who has experienced nearly every type of acne, I know very well when I’m having a hormonal, PCOS-induced breakout or a regular one from a bad reaction to a skincare product or not taking my makeup off well enough. Other than its distinct placement along my jawline, my hormonal acne is much more severe and painful than regular acne. According to the American Academy of Dermatology Association, more severe, cystic acne is more likely to cause scarring, and I find that my scars also take far longer to heal, too.
PCOS doesn't always lead to acne.
Acne isn’t always PCOS’s unwelcome sidekick (one of my best friends with PCOS has flawless, glass-like skin). The severity of acne depends on a multitude of factors that all contribute to PCOS, from testosterone and estrogen levels, to the state of the gut microbiome and level of inflammation throughout the body, according to Dr. Gersh.
But, there are external factors that play a role in hormonal acne, too. “Everything has an effect on your hormone levels, from the time you eat, to the levels of environmental toxins [including BPA and parabens] you’re exposed to,” Dr. Gersh says.
Medication can treat PCOS-induced acne.
“Cystic, hormonal acne often requires prescription oral antibiotics because the topical medications often don’t travel deep enough into cysts,” says Dr. Jegasothy. Dr. Gersh agrees that PCOS is amongst one of the most difficult types of acne to treat. The fastest and most noteworthy fix for my acne was spironolactone, a diuretic medication prescribed by my OB-Gyn. After I began taking it, my acne started to clear up within two weeks.
When clients do request something topical to treat acne, Dr. Jegasothy typically prescribes them Epiduo Forte, a gel combining a retinoid and benzoyl peroxide. Dr. Gersh also recommends Epiduo Forte, along with products that have salicylic acid (my favorite is Juice Beauty Blemish Clearing Serum for its ability to gently resurface skin without irritating it) and azelaic acid (like this potent The Ordinary Azelaic Acid Suspension, which I count on for reducing redness and inflammation quickly).
There are also oils that can be effective on acne-prone and even oily skin, like those containing lavender oil, according to Dr. Gersh. As a natural treatment, she recommends her patients dab some lavender oil like this one from Vitruvi on superficial pimples. Lavender oil has pathogenic bacteria-killing properties, Dr. Gersh says.
With other topical products that contain more ingredients, Dr. Jegasothy warns her clients with PCOS to read ingredient labels carefully. She says to watch out for ingredients like stearate and mineral oil. Though they might be ingredients in products that make your skin feel super soft to the touch, stearate and mineral oil can clog your pores, creating an environment that invites acne to form, Dr. Jegasothy explains.
Over-the-counter skincare products, particularly from clean beauty brands, can also help.
Cutting mineral oil out of my routine has also made a huge difference on my skin. The ingredient lurks in a lot of our skincare products, and is known for its silky soft finish on the skin. But, I've found it also can create a pore-clogging barrier, like Dr. Jegasothy mentioned, that makes my acne worse.
For me, ensuring I have a good cleanser that doesn't irritate or strip my skin of its natural oils has been key. A clean, Ayurvedic cleanser like Ranavat’s Luminous Ceremony Creamy Cleanser not only preserves the good bacteria and suppleness in my skin, but also primes the rest of my skincare routine to make sure my serums, moisturizers, oils, and masks can be better absorbed.
I really prioritize buying from brands specifically made for and by women of color with PCOS, and with clean ingredients at the forefront of their mission (like Realm Concept Market). Clean beauty is important to me for many reasons, but according to Dr. Gersh, it's particularly integral for someone with PCOS, in order to eliminate a long list of product ingredients that can be irritants. “Women with PCOS have imbalances with their hormones, but using organic, natural, clean products on the skin can help women with PCOS to re-establish a healthy hormonal balance,” says Dr. Gersh. “Placing irritating, potentially hormone-disrupting chemicals on the skin can exacerbate the hormonal imbalances already present, potentially worsening skin health.”
One more product I love is Realm Concept Market Tea Tree Heaven Argan Oil. It has antibacterial tea tree oil and antioxidant-boosting argan oil, and is my go-to when I want a product that’s just as nourishing as it is clarifying. Whenever I use it at night, I wake up with super glowy skin, which is always my goal.
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