Acne in PCOS: Diet & Lifestyle Changes to Improve Your Skin

PCOS

May 22

Polycystic Ovarian Syndrome (PCOS) is a common endocrine disorder affecting 6-20% of reproductive age females characterised by hyperandrogenism (excess androgen production), a hormonal imbalance that causes ovary dysfunction, infertility, and skin problems (1).

This article will cover common skin issues associated with PCOS. So if you are struggling with cystic acne or something similar, are embarrassed to go out with friends or find yourself spending hours covering up your skin before you leave the house in the morning, then read on for some tips on how to treat and manage PCOS related acne.

What are skin disorders?

Skin disorders are conditions that lead to changes in the skin, which is the largest organ in the human body. These changes are often caused by inflammation. People with PCOS are more likely to experience skin issues and the most common types of skin conditions in PCOS include (2):

Acne: an inflammatory skin disorder that happens when follicles under the skin are blocked, trapping oil, dead skin, and bacteria in the pores.
Skin tags (acrochordons): harmless soft, skin-coloured growths on the skin, mainly on the neck, eyelids, and underarms.
Acanthosis nigricans: a velvety, darkening, and thickening of the skin, mainly at the back of the neck, underarms, and groyne.
Hirsutism: the excessive dark and thick hair growth in specific body parts, mainly the face, chest, abdomens, lower back, and upper arm.

How can PCOS cause skin disorders?

Acne is common in people with PCOS, especially during puberty, affecting around 14–25% of people with PCOS (3), depending on their ethnicity and age.

Hormonal imbalance is a common feature of PCOS, with insulin resistance and increased insulin levels being the most common feature. Increased insulin levels can promote inflammation that leads to oily skin and the onset of acne (1). Insulin can also promote the growth of skin cells, causing the formation of skin tags and acanthosis nigricans.

Furthermore, high insulin levels can increase the production of androgens (e.g. testosterone) which leads to increased sebum production, resulting in acne and excessive hair growth. The hormonal imbalances in PCOS can also affect the skin structure and contribute to the development of skin tags and acanthosis nigricans.

In addition, changes in the gut microbiome in people with PCOS are thought to contribute to acne development. Several studies have pointed out that the different structures and composition of gut microbiome in PCOS women are related to increased inflammation levels and insulin resistance that can cause acne (4).

Is there an effective treatment for skin conditions?

For many people with PCOS, experiencing skin issues can be a huge source of stress. It can massively affect body image and self confidence and many are not happy with their appearance. So if this feels like you then know you are not alone. The good news is there are multiple treatment options to improve skin health and hopefully improve body image as well as boost confidence levels.

Medication

When it comes to available medicines your doctor may prescribe to help treat acne, the first-line treatment is usually topical agents or creams. These may be cleansing, antibacterial, antibiotic or antiseptic, or they may contain other active ingredients which work on the irritated skin areas. Different medications are usually recommended based on severity of the acne:

Mild acne: can be treated by using benzoyl peroxide (an antiseptic) and/or a topical retinoid which has been shown to help unblock clogged pores

Moderate and severe acne: doctors may either prescribe oral antibiotics (like doxycycline or lymecycline) combined with topical agents (5), or they may trial a drug called isotretinoin (commonly known as Roaccutane). Although isotretinoin can be very effective for some people, it can also have some serious side effects like mood changes, high cholesterol, dry eyes and skin, as well as having extremely harmful effects on unborn babies. Therefore it is not recommended in all cases and needs to be discussed with your doctor in detail.

In some cases, where there is more of a hormonal cause, then a contraceptive pill may be used to influence oestrogen, progesterone or androgen levels leading to a reduction in inflammation and reduced sebum production (5).

If you are interested in exploring medical treatment options then why not contact your doctor to discuss your options.

2. Removal of Skin Tags

There are various treatment options for skin tags that cause minimal discomfort and won’t affect your daily routine. These methods include surgical procedures, cryotherapy, and laser treatment and should be discussed with your doctor or a specialist surgeon.

3. Diet

Given hormone levels can be so influential in the development of skin conditions, changes in diet that help manage hormones, such as insulin and androgens, are pivotal in managing skin disorders in people with PCOS. Here are some dietary strategies you might want to try:

Low GI Foods & Whole Grains

The consumption of high glycemic index (GI) food, such as sugary foods/drinks, potatoes, white bread, and rice, causes hyperglycemia, increasing the secretion of insulin in the bloodstream (6). Therefore, replacing high glycemic index food with low/medium glycemic index food, such as green vegetables, whole grain bread, and legumes, will regulate the amounts of insulin secretion and decrease the levels of androgen and sebum production (6).

Full Fat Dairy

When it comes to dairy foods, you may have heard that they are linked to inflammation. However the evidence for this is poor and in fact studies suggest that in PCOS especially, full fat milk might be protective of health. If you use low-fat dairy (e.g. skimmed milk) then you may want to try to replace it with full-fat dairy products since low fat dairy has been suggested to increase the secretion of a hormone called insulin growth factor 1 (IGF-1) which is linked to increased androgen levels (7).

Alcohol

Although there have been no direct links between alcohol and the development of acne, moderating alcohol intake may help you control your blood sugar levels and improve your overall skin health (8). This is because alcohol can negatively impact the immune system, liver function, inflammation, and hormone health - all of which may reduce skin health and contribute to acne.

Antioxidants

When it comes to skin health, there is a lot of hype about antioxidants which are important to protect against free radicals that damage our skin, and many skin care products include an array of antioxidants as their key ingredients. When it comes to managing acne, antioxidants have been shown to have anti-inflammatory effects which can also result in a decrease in insulin and androgen levels (9). Some examples of antioxidants and their food sources are listed below: :

Omega-3 fats: fish, nuts, seeds, plant-based oils
Vitamin C: citrus, strawberries, broccoli, brussel sprouts
Polyphenols: blueberries, raspberries, cocoa powder, green tea
Vitamin E: olive oil, avocado, peanut butter, walnuts
Vitamin A: orange and yellow fruits and vegetables (carrots, sweet potatoes, red peppers, pumpkin, mango, papaya), beef liver

Optimising intake of some of these nutrients, such as vitamin A, C, and E has been linked to improvements in skin quality, and reduced sebum production. Although it may be tempting to use a supplement to optimise your antioxidant intake, there is not enough conclusive evidence to make generalised supplement recommendations to manage PCOS related acne.

Many of the nutrients listed above are found in many foods and so it can be easy to consume dietary sources. If you struggle to do so then why not talk to a dietitian who can make more personalised recommendations of which supplements might be beneficial in managing your acne and PCOS.

4. Exercise

Physical activity plays a crucial role in managing skin conditions in women with PCOS and has general benefits in overall health. Regular exercise contributes to increased blood flow and circulation, boosts oxygen levels to the skin, and relieves stress. In addition, physical activity is associated with decreased testosterone and glucose levels, as well as increased production of endorphins (our happy hormones), and an overall anti-inflammatory effect (10).

If you aren't already moving your body regularly then your skin health and acne may improve by adding in a form of movement that you enjoy and want to do regularly.

5. Stress management

Much like other aspects of PCOS, stress can have a big impact on skin health. Increased stress levels lead to increased cortisol production which triggers the secretion of testosterone (11). Stress management can be beneficial to relieve acne and other skin issues so why not try some of the following stress management techniques:

Stay active. Keeping yourself active by doing any type of exercise will help you reduce your stress hormones and keep your insulin and androgen levels down.
Practice mindfulness. Meditation and breathing techniques can help you escape from your stressful moments, control your anxiety, and relax during your everyday life.
Restful sleep. Getting enough sleep will make you feel more relaxed and productive and therefore you will be more able to overcome stressful situations.
Talk. Expressing yourself by sharing your thoughts and anxiety and discussing your problems with close friends and family can help you remove stress.
Self-care. Give time to yourself to escape from work and do things that make you happy. Read your favourite book, meet a friend, travel.

6. Skincare routine

Much like supplements, skin care products are not magic solutions to problems like acne, however they can be a good opportunity for a moment of self-care and a good skin care routine can contribute to improvements in skin health. A good skin care routine might include:

Cleansing day and night with a dermatologically tested soap
Moisturising day and night with cream for your specific skin type
Sun protection
Appropriate targeted ingredients or medications. Some active ingredients for acne treatment might include things like retinoids, niacinamide, benzoyl peroxide or salicylic acid, however each ingredient has a different role and is suited to different types of acne.
Speaking to a dermatologist who specialises in skin conditions like acne to get skin care recommendations. I highly recommend Dr Thivi Maruthappu and her book Skin Food.

So can diet & lifestyle changes help skin conditions in PCOS?

As we have discussed, diet can play a huge role in treating PCOS related skin disorders . Dietary strategies to trial may include the replacement of high glycemic index foods (potatoes, white bread, and rice) with low/moderate glycemic index foods (wholegrain bread, legumes, green vegetables) including whole grains, opting for full-fat instead of low-fat dairy products, reducing alcohol intake, and adding foods high in antioxidants. In addition, making general lifestyle changes including diet, exercise and sleep and stress control can not only help improve your skin health, it will also help you improve your PCOS and PCOS related symptoms overall.

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