Medically reviewed by Vicky Davis, FNP
Written by Our Editorial Team
Last updated 1/11/2022
Acne breakouts can occur for a variety of reasons, from hormonal fluctuations to cosmetics that clog your pores and affect your skin.
One less well-known cause of acne in many women is polycystic ovary syndrome, or PCOS — a common disorder that can affect your hormone levels, fertility and general health.
If you have PCOS, you may notice that you’re more prone to acne breakouts than other women and that your acne breakouts are more challenging to treat.
Like other forms of acne, acne from polycystic ovary syndrome is treatable. Below, we’ve talked about why PCOS causes acne, as well as the common signs that you may notice if you’re prone to acne breakouts from PCOS.
We’ve also shared proven, science-based treatment options that you can use to get rid of acne from PCOS and prevent it from coming back.
Polycystic ovary syndrome is a common health problem that develops in women of childbearing age, says the United States Office on Women's Health.
It affects between five and 10 percent of women between the ages of 15 and 44, with most women discovering they have PCOS at some point in their 20s or thirties.
Although researchers aren’t yet aware of the exact cause of PCOS, research suggests that a hormone imbalance -- specifically high levels of androgens, or male sex hormones -- is a key contributor to its development.
In addition to higher-than-normal androgen levels, the Office on Women's Health also says that certain genetic factors and high levels of insulin (a hormone that controls how food is converted into energy) also play a role in the development of PCOS.
PCOS can cause a range of symptoms, including an irregular menstrual cycle (frequently late or missed periods), excessive hair growth on the body (hirsutism), female pattern hair loss, weight gain, darkening of your skin, skin tags and acne breakouts.
In addition to these symptoms, PCOS can increase your risk of developing certain other health problems, especially if you are overweight. Health issues related to PCOS include:
Infertility. Many women with PCOS experience difficulties becoming pregnant. Reduced fertility from PCOS is often treatable with lifestyle changes and the use of medication. In some cases, women with PCOS use options such as IVF to become pregnant.
Development of cysts on the ovaries. When PCOS delays your menstrual cycle and ovulation, it can lead to the growth of ovarian cysts. In some cases, these cysts may cause discomfort or pain during physical activity or sex.
Heart disease. According to the CDC, women with PCOS are more likely to develop elevated levels of LDL, or “bad,” cholesterol. This results in an increased risk of developing heart disease at some point in life.
High blood pressure. Women with PCOS also have an elevated risk of developing high blood pressure, or hypertension. High blood pressure may contribute to other long-term health issues.
Diabetes. Women with PCOS have an increased risk of developing diabetes. More than half of all women with PCOS develop type 2 diabetes by age 40, and the risk of diabetes during pregnancy (referred to as gestational diabetes) is higher for women with PCOS.
Obesity. According to The Science Journal of the Lander College of Arts and Sciences, women with PCOS have an elevated risk of developing obesity. While not directly caused by PCOS, metabolic issues and insulin resistance brought on by the disorder could eventually lead to obesity down the line.
To understand how PCOS causes acne, it’s important to quickly go over the basics of how and why acne breakouts occur in PCOS patients.
All acne vulgaris, from mild comedonal acne to painful cysts, develops when your hair follicles, or pores, become clogged due to a combination of sebum and dead skin cells.
According to an article published by StatPearls, sebum is a type of oil that’s secreted by your sebaceous glands. It’s important for keeping your skin moisturized and protected from germs, but when it builds up on your skin, it can fill up your pores and cause them to become clogged.
Dead skin cells, on the other hand, are produced as a byproduct of your skin’s natural process for repairing and maintaining itself, referred to as epidermal turnover.
As the outermost layer of your skin replaces itself every 40 to 56 days, dead skin cells are shed into the environment, says an article in the New York Academy of Sciences.
When these cells don’t shed, they can mix with sebum and contribute to clogged pores and acne breakouts, according to the American Skin Association.
Acne breakouts can range in severity from mild to severe. Severe acne breakouts often happen when the bacteria that grow on your skin, such as Propionibacterium acnes (P. acnes), begin to multiply inside a clogged pore.
So, how does PCOS fit into this? Behind the scenes, a variety of different factors all play a role in your body’s production of sebum and dead skin cells. According to another StatPearls article, one of these factors is your body’s production of androgen hormones such as testosterone.
Testosterone and similar hormones can bind to receptors throughout your skin and cause your sebaceous glands to secrete more sebum.
The higher your androgen levels, the more active your sebaceous glands become, causing your skin to become oilier and more acne-prone.
Although androgens are usually referred to as male hormones, both men and women produce them.
Because PCOS involves excessive androgen production, it often results in oily skin and an elevated risk of dealing with acne breakouts.
This increase in androgen production is also the root cause of other PCOS symptoms, such as excess hair growth and androgenetic alopecia (female hair thinning).
Our guide to the androgen hormones that cause acne explains more about how hormones play a role in sebum production and acne breakouts.
Just like acne that occurs on its own, PCOS acne can vary hugely in severity, from a few small pimples to severe, persistent acne breakouts.
According to an article published in the journal, Minerva Ginecologica, if you have PCOS acne, you may notice the following symptoms:
Comedonal acne. Comedones are small, non-inflammatory acne lesions that develop when your pores become clogged. Blackheads and whiteheads are common forms of comedonal acne.
Inflammatory acne. Inflammatory acne develops when acne lesions become infected with bacteria and inflamed. Common types of inflammatory acne include pustules and papules, which can have a red, swollen appearance.
Nodular and/or cystic acne. When acne becomes severe, it can develop into nodular or cystic acne. This type of acne develops below the surface of your skin and can leave behind scarring when it clears.
Body acne. If you have PCOS, you may also notice acne that develops on your chest, back and other parts of your body.
Acne from PCOS usually looks the same as acne that develops on its own. Our full guide to the most common types of acne goes into more detail about the forms of acne you may notice if you get PCOS-related acne breakouts.
Like other forms of acne, acne caused by PCOS is treatable. Depending on the severity of your acne, you may be able to treat it using over-the-counter products, prescription acne medication, or by making changes to your skincare routine.
We’ve discussed treatment options for PCOS-related acne below, along with information on how each treatment works.
If you only have mild acne from PCOS, you may be able to treat it with over-the-counter acne cream, cleanser or other treatment.
When you’re shopping for acne treatments available over the counter, it’s always best to look for products that contain science-based ingredients. Look for the following active ingredients to stop mild acne breakouts from forming:
Benzoyl. According to StatPearls, this ingredient works by stopping the bacteria that cause acne from multiplying on your skin. You can find benzoyl peroxide in many over-the-counter acne cleansers, foaming washes and other topical products.
Alpha-hydroxy and beta-hydroxy acids. An article in the journal, Molecules, says that these ingredients work by peeling away the dead cells that can build up on the surface of your skin and cause acne breakouts. They are usually referred to as AHAs and BHAs. Popular AHAs and BHAs include glycolic acid, lactic acid and salicylic acid. You can find these ingredients in facial cleansers, serums and other skincare products formulated to promote exfoliation.
Over-the-counter retinoids. These ingredients work by promoting the peeling of dead skin cells. Common over-the-counter retinoids include retinol and adapalene (available as Differin® gel), says a review in the journal, Advances in Dermatology and Allergology.
Our guide to the best over-the-counter acne treatments lists other ingredients that may help you to deal with mild acne breakouts.
While over-the-counter products are often enough to deal with mild to moderate acne, if you’re prone to severe or persistent acne breakouts, you may need to use prescription medication.
Used as directed by your healthcare provider, prescription acne medication can get your acne breakouts under control and improve your skin’s appearance.
Common prescription acne medications include:
Tretinoin. The National Library of Medicine says that tretinoin, a topical retinoid, works by peeling dead skin cells and unclogging your pores. This helps to get rid of acne breakouts and improve your skin’s all-around appearance. In addition to treating acne, tretinoin is known for its anti-aging effects. In fact, it’s often used as a topical treatment for wrinkles, discoloration and rough-feeling skin. Tretinoin is one of several active ingredients in our Prescription Acne Cream, which is available online following a consultation with a licensed healthcare provider.
Clindamycin. A topical antibiotic, clindamycin reduces swelling and stops the bacteria that cause inflammatory acne from growing on your skin, according to the National Library of Medicine. Like tretinoin, it’s an active ingredient in our Prescription Acne Cream.
Isotretinoin. An oral acne medication, isotretinoin is powerful and highly effective but can cause side effects. Your healthcare provider may prescribe this medication if your acne doesn’t improve with other treatment options.
It’s often possible to control your acne breakouts by taking the combined oral contraceptive pill, or birth control pill.
Birth control pills treat acne by regulating your body’s production of certain hormones, including the androgens that can cause hormonal acne breakouts.
Research from the American Academy of Dermatology Association shows that the pill can treat comedonal acne such as blackheads and whiteheads, as well as nodular and cystic acne.
The birth control pill also helps to control other symptoms of PCOS, such as an irregular period and excessive facial or body hair growth.
Not all birth control pills treat acne. Currently, the FDA has approved three pills — Yaz®, Estrostep® and Ortho Tri-Cyclen®, as well as their generic equivalents — as treatments for hormonal acne.
You can find out more about how these pills work, as well as how you can use them to get rid of acne breakouts, in our full guide to birth control and acne.
Don’t use birth control yet? We offer several generic birth control pills online, including pills that are designed to treat hormonal acne breakouts.
Since PCOS acne is caused by excess androgens, it’s often treated with medications that lower your androgen hormone production.
One of these is spironolactone, a medication that’s often prescribed to treat water retention and high blood pressure.
By reducing the effects of androgens, spironolactone often helps to get rid of stubborn hormonal acne, including acne that affects the jawline and lower face
Like hormonal birth control, spironolactone can also treat excess body or facial hair growth — a common issue for women with PCOS.
If you’re prescribed spironolactone, your healthcare provider will likely recommend using it with the birth control pill.
This not only makes it more effective at treating hormonal acne, but it’s also important for preventing pregnancy, as spironolactone can cause birth defects.
Our full guide to spironolactone and acne goes into more detail about how this medication works as an acne treatment, as well as the latest research on its effectiveness.
Another medication that’s sometimes used to treat PCOS-related acne is metformin. A diabetes medication, metformin works by controlling blood sugar levels.
Research published in The Journal of Clinical and Aesthetic Dermatology has found that metformin treats hyperandrogenism, the excessively high testosterone levels caused by PCOS.
Thanks to its effects on androgen levels, it also lowers the severity of PCOS-related acne breakouts.
If you’re prescribed any type of anti-androgen medication for PCOS, make sure to closely follow your healthcare provider’s instructions and inform them if you experience any side effects.
While making a few changes to your habits and lifestyle may not be enough to stop PCOS acne on their own, lifestyle changes can have an impact on your skin health and make medication for acne more effective.
Try the following lifestyle changes and techniques to reduce the severity of your acne:
Wash your skin twice a day, plus after sweating. The American Academy of Dermatology Association says that washing regularly helps to prevent bacteria from building up on your skin. Try to wash acne-prone areas each morning and evening, as well as after workouts or other activities that make you sweat.
When you wash, avoid scrubbing your skin aggressively. This can irritate your skin and make acne worse. Instead of scrubbing, be gentle and carefully wash your face or other acne-prone areas with warm water and your fingertips.
Stop using products that clog your pores. According to the American Academy of Dermatology Association, lots of cosmetics and skincare products contain oils that can clog your pores and contribute to acne. By using these products, you increase your risk of dealing with persistent breakouts. To reduce your risk of developing acne, look for products labeled “non-comedogenic” or “oil-free.” These are designed for oily skin and are less likely to cause breakouts.
Avoid popping your pimples. Not only is this an ineffective way to get rid of acne — it’s also a potential cause of infections and acne scarring, says the American Academy of Dermatology Association. Instead of popping pimples, use proven acne medication to bring your breakouts under control. If you have severe acne that needs professional treatment, it’s always better to contact a dermatologist than to attempt to extract it by yourself.
Try not to touch your face. Touching your skin can spread bacteria into your pores and make your acne breakouts more severe. If you need to touch your face to apply an acne treatment, make sure to thoroughly wash your hands first.
If your skin is irritated easily, stick to gentle products. Alcohol can dry out your skin, which may make your acne more visible. If you have sensitive skin, try to stick to gentle products that contain little or no alcohol.
Dealing with PCOS can be a frustrating experience. Not only can it affect your appearance, but it can also have a negative effect on your fertility and general health.
The good news is that PCOS is treatable. If you think that you have PCOS, it’s important to talk to your healthcare provider.
They may ask you about your symptoms or perform a pelvic exam, ultrasound or blood test to check for common signs of PCOS.
By working with your healthcare provider, you’ll be able to put together a PCOS treatment plan that improves both your skin, your overall health and your quality of life.
If you need specific help with acne, you can access our prescription acne products online. You can also learn more about the best ways to deal with acne in our complete guide to preventing acne breakouts.