This site contains affiliate links. I may earn a small commission, at no extra cost to you.
TikTok will tell you PCOS acne can be fixed with one “miracle” cleanser or serum, and unfortunately they’re trying to sell you something. Polycystic ovary syndrome (PCOS) is a hormonal condition, and the acne comes from those hormonal imbalances.
That means in order to fix PCOS acne, you need to address it inside and out. In most cases, no single topical treatment is going to do the trick. However, you can still get clear skin with PCOS.
In this blog post, I’m going to talk about possible hormonal acne treatment plans and suggestions that addresses the internal root issues of acne and supports your skin on the surface. This is not medical advice, this is just what I’d do if I were in this situation.
How to treat PCOS acne: hormonal solutions for clearer skin
When you have hormonal imbalances, you may feel it, but you can often actually see it too. Excess hair growth on the face and body, female-pattern baldness, and acne are all common with PCOS-related hormonal imbalances.
So, the key is manipulating the hormones into a more favourable place and choosing skincare products that address the issues hormonal imbalances cause. You’ll need ones that regulate oil, kill bacteria, reduce inflammation, and unclog pores. This will work in tandem alongside whatever regime your doctor or dermatologist is suggesting in terms of medication or lifestyle changes.
Does PCOS cause acne?
Yes. PCOS causes acne through insulin resistance and high androgen hormone levels (AKA high testosterone levels). Both are really common with this condition. Sometimes you’re actually just extra sensitive to the androgens you make, rather than having too much of them – it’s a complicated relationship!
Elevated androgen levels and/or high testosterone increase oil production, making your skin greasy and the perfect environment for bacterial growth. Even with a normal cell turnover rate, this can make dead skin cells stick together and block pores more than usual.
Then insulin resistance, which is basically your body’s inability to stabilise blood sugar levels, encourages even more testosterone production. Plus, both trigger inflammation. Inflammation then can irritate your skin and the pore lining, causing angry cysts that are hard to get rid of.
What does PCOS acne look like?
PCOS acne is mainly on the lower face. It’s around the jawline, chin, and neck. Sometimes it’s on the cheeks, too.
They’re usually cystic pimples that go deep, causing them to be really painful beneath the skin. Irritation from inflammation makes it even worse. Cystic pimples will be the ones that rarely break the surface to come out as whiteheads or blackheads. This doesn’t mean if you have PCOS, you won’t experience any comedonal acne. PCOS acne might mean cystic to one and comedonal to the other.
Usually, the acne will change throughout your menstrual cycle because of those hormone fluctuations. The worst of your acne is just before your period or during, in the luteal phase. Learn more about PCOS acne vs. regular acne in this post.
How to get rid of PCOS acne
Take hormone-balancing supplements
I’m gonna stop here and say that the term ‘hormone balancing’ is now being way overused online, I am only using it here because we all know what’s trying to be said. When we use the term, we’re all on the same page.
There are a lot of supplements that help balance your testosterone levels. Research shows that one of the best is Zinc picolinate.
Zinc picolinate is one of the top supplements recommended by dermatologists for acne. Past studies have shown that people with acne are often deficient in zinc, so you want to be sure to cover that base.
Another that can be beneficial is inositol. It can reduce both testosterone and insulin resistance, leading to less oily skin and therefore breakouts.
A common supplement for inflammation is omega-3s. Anything that lowers inflammation can help PCOS in the long wrong, as the goal is to get your body back to homeostasis.
As always before starting anything new, I recommend talking to your GP first.
Drink spearmint tea
Research finds that spearmint tea is anti-androgenic, meaning it can lower testosterone levels and improve hormonal acne. It’s also caffeine-free, an even bigger win.
Drink spearmint tea once or twice a day to give your body a natural boost and clear up your skin. If you’re not keen on tea, you can try spearmint capsules.
Don’t buy peppermint tea! Similar in taste, completely different in effects.
Eat a mindful and balanced diet
I’ve talked a lot about how your gut and acne are connected. Even if you think you’re doing everything right, there are loads of sneaky triggers. Ultimately, if your gut is out of wack, it’s most likely impacting your hormones.
To see clearer skin, I recommend cutting sugary, fried, and/or processed foods. Not are these more likely to raise insulin levels constantly, but they also trigger inflammation in the body.
Instead, focus on lots of protein and whole, anti-inflammatory foods. Inflammatory foods include those I listed before – cutting dairy and gluten is quite controversial. Personally I’ve seen a lot of good evidence that dairy increases IGF1, therefore causing more acne. I personally don’t eat it because it 100% gives me spots! It might be worth cutting those out to see if it helps clear your skin.
For more on hormone-balancing, skin-friendly foods, read this post about the best foods for clear skin.
Practice stress management and cut back on caffeine
I’ve talked a lot about how insulin resistance raises testosterone levels, but there’s another hormone at play. Cortisol (your stress hormone) worsens androgen levels and, obviously, acne.
It’s probably not surprising to you that cortisol contributes to acne. We all know stress is generally a bad thing, but when it’s elevated for unnaturally long periods of time is when it becomes a problem.
We all see those breakouts when we’re super stressed out, so managing stress is essential.
Stress management can look like a lot of things–walking, journalling, yoga, practicing gratitude, and doing your favourite hobbies are a good start. However, it’s also a good idea to cut excess caffeine.
Yes, I know we all love our morning tea, coffee, or Celsius, but caffeine is basically liquid stress. It gives us energy, but it also raises cortisol and adrenaline. I would try to limit your caffeine to one cup per day and in the morning with food, you don’t need to entirely cut it out.
You can also try to find decaf alternatives to your daily vice. Cortisol raises your insulin levels, and high insulin levels raise your testosterone. The result? Acne. It won’t matter so much if this is only happening here and there, but if it’s daily and chronic, after a while this is going to show up in your skin.
Do low-impact, meditative workouts
The benefits of exercise go beyond weight loss. It can lower insulin resistance, inflammation, and cortisol levels naturally, while also balancing hormones. If you’re tracking it, that’s a win-win-win-win.
However, avoid workouts that are super intense like excessive HIT classes. They can then have a reverse effect on cortisol, insulin, and inflammation.
Do exercises that are more relaxed like yoga, walking, swimming, Pilates, and strength training with weights.
Use a serum with salicylic acid, benzoyl peroxide or azelaic acid
So far, I’ve talked a lot about what to do on the inside. This is because if your hormones aren’t balanced, you’ll constantly battle acne with PCOS. But there are topical products that can help, too.
One of the main issues of high testosterone is all that excess oil and dead skin cells build up. It sits on your skin, clogs your pores, and makes your face a magnet for bacteria.
To fight this, I recommend using a serum that contains either salicylic acid (like Inkey List BHA Serum), benzoyl peroxide (like Acnecide gel) or azelaic acid (like Dermatica 15% azelaic acid serum). All three can work to improve acne, but you’ll want to avoid using them all at the same time as that can damage your skin barrier.
Each active works in different ways:
- Salicylic acid penetrates deep into pores to dissolve dead skin cells and excess oil.
- Benzoyl peroxide combats inflammation and kills acne-causing bacteria.
- Azelaic acid is good at soothing the skin and preventing acne marks. You can use this with most other actives and when you’re pregnant.
Each of them can be drying, so go slowly whichever you choose – they can dry out your face and remove all natural oils, which can feel painful. The last thing you want is redness and itchiness on top of acne.
My favourite active (ever, pretty much) is a retinoid – more on this later.
Consider using a niacinamide serum
Niacinamide (vitamin B3) serum is great for hormonal acne, which is one of the reasons it’s popular with Korean skincare. Something like Beauty of Joseon: Glow Serum: Propolis + Niacinamide is smart to add to your morning and evening skincare routine.
Niacinamide works because it balances oil, reduces inflammation, and strengthens the skin barrier. And if you’re dealing with acne-scarring, which is pretty common with hormonal acne, niacinamide can help with that too. You can also mix and match niacinamide with most other actives without having to worry about reactions.
Use a retinol product at night
Retinoid products are also helpful. They speed up cell turnover, so skin cells don’t have the opportunity to clog pores. They help reduce oil production, reduce inflammation, and as a result, also fade acne scars.
That said, make sure you’re only using it at night, because some retinol breaks down in sunlight. So, for full benefits, only add it to your PM routine. However, be careful when using salicylic acid cleanser and retinol together, because they can overdry your skin if you’re not strategic. Same with BHAs and benzoyl peroxide.
To prevent side effects, only introduce one active at a time and wait 1-2 months to see how you react. You can also alternate the days you use your retinol if you see over-drying. Even if you’re currently dealing with oily skin, dry skin can be equally bad for acne-prone skin.
Need recommendations on retinols? Check out my post, “How to Use Retinol for Beginners.” You can find my full guide on how to start using a retinoid for acne here.
Keep your skin moisturised and use SPF even if it’s oily
As I said, dry skin isn’t the goal. You might be hesitant to use a moisturiser because your skin is already greasy, but your skin needs to be hydrated. If your skin isn’t moisturised, it might produce more oil to make up the difference. Obviously, not what we want.
Instead, keep moisturising as usual during your morning and evening routines. Just ensure you grab one of these moisturisers for clog prone skin. And while I’m on the subject, keep using a pore-friendly sunscreen. Sun damage will worsen acne marks and give you an uneven skin tone with time.
Consider hormonal birth control pills or Spironolactone
If you want to look at medical treatment options, there are acne medications out there that address the hormonal issues of PCOS.
Spironolactone is a popular one because it blocks androgens acting on the skin. Oral contraceptives can also increase SHBG and lower that free testosterone that trigger PCOS acne.
You don’t have to use medication, but it’s good to know these are available to you depending on who you are and how you react to different medications. So, just research the side effects and talk with your GP if you’re interested in going down the medication route.
Check out my Spironolactone review from when I used it for 6-7 months.
Address PCOS acne from the inside and outside for the best results
When we see acne on our faces, our instinct is to grab a new product. But most skin issues come from something going wrong on the inside and the outside. Make sure your solution gets to the root of the problem.
If this list feels a little overwhelming, just take it one step at a time. Soon, I’m confident you’ll find a full solution to your PCOS acne.
Like this post? You make also like:
- Best Skin Cleansers for Acne-Prone Skin
- Best Korean Skincare Products for Acne
- Can IBS Cause Acne?
- When to See a Dermatologist for Acne
