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How to treat hormonal acne caused by PCOS, according to a women’s health expert and a derm

This article was medically reviewed by Lauren Demosthenes, MD, OB-GYN, senior medical director at Babyscripts.
PCOS acne
Acne on the jaw is common in women with PCOS.
Obencem/Getty Images

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  • PCOS causes you to overproduce androgen hormones, which can contribute to acne.
  • Acne caused by PCOS may appear on your jaw, upper back, upper arms, and chest.
  • You can treat it with birth control pills, an anti-inflammatory diet, retinoids, and more. 

One in ten women of reproductive age have polycystic ovarian syndrome (PCOS), a condition that throws your hormones out of balance and can cause symptoms like missed periods, hair loss, fertility issues, and increased facial hair.

Because of this hormonal imbalance, more than a third of people with PCOS develop a severe form of acne that can be difficult to treat. But methods like hormonal birth control, retinoids, and changing your diet can help you manage PCOS acne.

The connection between PCOS and acne

PCOS is a disease that causes your ovaries to overproduce androgen, or "male", hormones such as testosterone and dehydroepiandrosterone (DHEA).

Excess androgens play a key role in the development of acne for two reasons:

  • It triggers your skin to produce more oil, which can clog pores and create pimples.
  • Androgen hormones decrease the cell turnover in your pores causing dead skin and oil to build up and clog pores.

"These two processes combine to aggravate both comedonal — black head type — and inflammatory — red pimple type — acne," says Dr. Rachel Reynolds, a professor of dermatology at Harvard Medical School.

PCOS acne may show up a little differently from regular acne. 

"The acne may develop in areas where girls and women don't usually get acne such as the jaw, upper back, upper arms, chest and buttocks," says Dr. Katherine Sherif, an internist and professor at Jefferson University who studies women's health.

How to treat PCOS-related acne

If you're struggling with PCOS acne, there are several remedies you can try both at home or under a doctor's care. 

1. Hormonal birth control

Combined birth control pills, which contain estrogen and progestin, can help control acne in PCOS.

This is because the hormones in the pill reduce the amount of androgen hormones produced by your ovaries, Reynolds says. 

2. Diet changes 

People with PCOS often have a form of chronic inflammation that can cause the ovaries to overproduce androgens. For this reason, it's important to follow an anti-inflammatory diet.

To treat PCOS acne, Sherif recommends making a few simple changes to your daily food routine:

  • Reduce simple carbs like bread, rice, pasta, crackers, and cookies.
  • Eat less meat, and when you eat meat, opt for grass-fed or pasture-raised.
  • Reduce fast foods.
  • Eat high-fiber foods like lentils, chickpeas, and leafy greens. 

3. Benzoyl peroxide 

Benzoyl peroxide is an acid found in many acne products that may help manage the symptoms of PCOS-related acne.

It works by removing dirt and oil from your pores, killing bacteria on your skin, and removing layers of dead skin.

You can find benzoyl peroxide as a cream, cleanser, or body wash at any pharmacy.

4. Antibiotics

If your acne is severe, you may want to try taking prescription topical or oral antibiotics to reduce the amount of acne-causing bacteria living on your skin.

Some of the most common antibiotics used for acne are:

  • Doxycycline
  • Erythromycin
  • Azithromycin

Your dermatologist will usually combine them with other treatments like benzoyl peroxide.

5. Retinoids

Retinol is a form of vitamin A that helps treat all types of acne by increasing the rate you produce new skin cells. This helps keep your pores clear of buildup like oil and stops pimples from forming.

Retinol often comes as a skin cream, which is helpful for mild acne, but "the oral retinoid, isotretinoin, can be helpful in reducing severe acne in patients with PCOS," Reynolds says.

You can find retinol creams at many pharmacies, but you'll need to get a prescription from your dermatologist for isotretinoin pills.

You'll probably need to keep up retinol treatment over the long term — "patients with PCOS may be more likely to relapse with acne as compared to people without PCOS," Reynolds says. 

6. Spironolactone

You can also block androgens like testosterone from circulating through your body and causing acne by taking prescription testosterone-blocking medication such as spironolactone.

But this medication may not be right for everyone — "it's important to remember that spironolactone is not safe in pregnancy or breastfeeding," Sherif says.

Insider's takeaway

PCOS is a hormonal condition that can cause severe acne. You can treat PCOS acne using common acne treatments like retinol and benzoyl peroxide, as well as hormone-balancing medications.

"Birth control pills and spironolactone in particular can be very effective treatments for acne in women with PCOS who do not improve with topical therapy alone," Reynolds says.

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