If you have PCOS, you have likely experienced PCOS acne at one point or another.

Unlike pesky everyday pimples, PCOS acne can be both incredibly stubborn to treat and very distressing. It can leave scarring and redness that can, understandably, have a huge impact on self-esteem and mental wellbeing.

But, what actually causes PCOS acne, what does it look like (compared to fungal acne), and how can it be treated?

What causes PCOS acne?

PCOS is associated with an imbalance of hormones, and high levels of androgens (commonly referred to as “male” hormones), such as testosterone, appear to be both a cause and a symptom of PCOS. 

Raised levels of androgens – a condition known as hyperandrogenism – play a big role in the causation of PCOS acne. Androgens trigger the skin’s glands to produce excess sebum – an oily mixture of fatty acids, sugars, and other natural substances that work to moisturise the skin and protect against water evaporation. Excessive sebum can build up inside hair follicles, causing acne.

How do I know if I have PCOS acne? – The key signs to look out for

1. Large red cysts

PCOS acne tends to manifest as large, red cysts and tender knots that sit beneath the skin, as opposed to fine surface pimples and blackheads. 

2. Chin, neck and jawline spots

Hormonal or PCOS acne commonly affects the lower face, including the chin, neck, and jawline. Although, it’s worth bearing in mind that not every case of acne in the lower face is linked to PCOS, and is not on its own a sign of PCOS.

3. Spots that are painful and slow to heal

PCOS acne can be hard to treat and incredibly stubborn. Cysts can cause significant pain, unlike the discomfort often caused by regular spots, and can lead to scarring and redness.

4. Acne that worsens around the time of your period

It’s common to experience PCOS acne flare-ups in the lead-up to, and whilst you’re on, your period. This is because more sebum is produced, clogging pores and resulting in large cysts and lesions. 

How to start healing your PCOS acne

Get your hormones under control

The combined pill, which contains both oestrogen and progesterone, is often prescribed to help people with PCOS manage their symptoms. This is because they work to reduce levels of androgens, which, if you suffer from PCOS acne,  can reduce the frequency and severity of flare-ups.

Oral contraceptives aren’t for everybody, though, so definitely explore your options before committing.

Anti-androgen medications, such as spironolactone, has been found to be an effective method of treatment for people experiencing hormonal or PCOS acne. They work by blocking androgen hormones, which reduces sebum production and therefore lessens the risk of acne flare-ups.

Again, it’s important to thoroughly discuss anti-androgens with your GP before beginning treatment.

Consider using BHA topical treatments

Retinoids, which are a class of compounds derived from vitamin A and are used to treat wrinkles and various skin issues, are sometimes used to help treat hormonal and PCOS acne. They come in both pill and cream form, and can help to unclog pores and reduce scarring. 

Retinoids make skin more sensitive to UV rays, so SPF is especially important to protect your skin.

Lifestyle changes

There’s little evidence that changing your diet can help to reduce PCOS acne outbreaks, but there is reason to believe, according to research, that stress can worsen acne flare-ups. This could be linked to hormonal changes, or an increase in habits such as face- and pimple-picking. Either way, we can all agree it’s a good idea to keep stress to a minimum.

Prioritise your mental wellbeing by eating nourishing foods, moving your body in ways you enjoy, and working activities such as journalling and meditation into your day.

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