Why do women with PCOS have acne?
Remember when we chatted about androgens in the What is PCOS post? If it’s been a while since you read that post, go back and read it again for a quick summary of what androgens are and why they are elevated in women with PCOS.
Having an excess of androgens (due to insulin resistance and other causes)is what causes acne in many women with PCOS. One of these androgens, dihydrotestosterone (DHT), results in increased oil production. The increased oil production makes it more likely for your pores to get clogged with excess oil, dead skin cells, and bacteria which results in acne.
What can women with PCOS do to decrease their acne?
Your best friend used Proactiv for a month and now has flawless skin. Your cousin had a few bad years (ages 13-16) but now only gets a few pimples when her period is in town. Your co-worker says that you just need to wash your face more often. Why do these things not work for you?
Because the acne in women with PCOS arises from an underlying hormonal imbalance, the hormonal imbalance has to be corrected in order for lasting change to occur. Traditional methods of dealing with acne will likely have some positive results but they often do not result in permanent change for women with PCOS.
The most effective thing to do is to treat the underlying problem. If you want your acne to diminish, then you MUST take steps to get your hormones balanced out and your insulin sensitivity increased. No matter how diligent you are with washing your sheets and using a good moisturizer, your skin will continue to be plagued by acne until you deal with the hormonal imbalance that is causing it.
If you have not yet seen a doctor about your PCOS, or if it has been more than a year since you were last seen, please schedule an appointment. A doctor can help you establish a plan to get your PCOS under control. Because PCOS has a variety of symptoms, a variety of different medical specialties are frequently involved. PCOS is commonly treated by family practice doctors, OB/GYNs, endocrinologists, and dermatologists. I suggest you start with a family practice doctor and then go from there if needed. Research things a bit, and then go see a doctor!
When you visit with your doctor, there are a few medications that may be prescribed to you. More in-depth posts about these medications are coming; but, for now, here’s a super quick primer:
- Metformin. Metformin is prescribed to help women with PCOS be more sensitive to insulin. When insulin sensitivity increases (another way of saying that is that insulin resistence decreases), then acne also decreases.
- Spironolactone. Sprionolactone is prescribed to help reduce androgen levels in women with PCOS. When androgen levels go down, acne decreases too.
- Birth Control Pills. Birth control pills are prescribed to women with PCOS to help regulate menstrual cycles and decrease androgen levels. As with spironolactone, when androgen levels go down, the severity of acne will decrease.
In addition to medications, regular exercise and eating a wholesome diet will be of great benefit. This is not a trite response. You really do need to diet and exercise if you have PCOS. There’s no getting around it. As you exercise more frequently and eat more mindfully, your insulin sensitivity will increase and your symptoms will decrease. They really will.
I’m doing the basics (diet, exercise, medication). What else can I do to minimize acne?
Once you have the basics under control (seeing a qualified physician, exercising regularly, and eating appropriately), there are many additional tips that can help decrease your acne further. Acne is still a daily struggle for me, so I’m probably not the most qualified to offer advice. Hopefully some of you will share effective tips in the comments section! In the meantime, here are a few things that make a difference for me:
- Wash your sheets and pillowcases every week. If you can’t do your laundry that often, buy another set of sheets/pillowcases (put them on your Christmas list!) and then swap them out weekly.
- Wash your makeup brushes at least every week. I usually use shampoo or dish soap to clean them. Be sure to rinse well!
- When you wash/dry your face, use clean towels and washcloths. If you use rotating corners of the washcloth and towel, you can get by with using the same ones for a few days. Really though, you need more than one set. Buy enough that you can use a new washcloth and towel every two or three days (estate sales always have cheap towels and washcloths!).
- Avoid touching your face with your hands. Make a conscious effort to NOT touch your face unless necessary. When possible, wash your hands before you touch your face. If you are like me and sleep with your hands touching your face, then put a small blanket between your hands and face so that the blanket touches you (instead of your hands touching you). Be sure to wash the blanket every week when you wash the sheets!
- Avoid touching your face with your phone. When you use your cell phone, try to hold it in a manner that keeps it from being pressed against your skin. Use speaker phone when prudent. At least once a week, use rubbing alcohol to wash the parts of your phone that touch your face. If your job requires you to use a phone frequently, see if you can use a headset so that the receiver isn’t pressed on your face.
- Use a face wash with 10% benzoyl peroxide. My favorite is Clean & Clear Continuous Control Acne Cleanser. The Clean & Clear face wash was off shelves for a few months last year due to manufacturing issues, and my face was a nightmare. Now I hoard the cleanser. Be warned: no matter how careful you are, this product will bleach everything you own. Your towels will get spots, your bathmat will get spots, your sheets will get spots, and you may even develop some new highlights in your hair. Despite their name, “bleach friendly” or “benzoyl peroxide safe” linens are not exempt from its wrath. The easiest way to deal with this is to use all white sheets and towels. Alternatively, don’t use any linens you are super attached to. The spots won’t show up right away–they take awhile to appear.
- Find a good facial moisturizer. You may think that you need to dry out your face to get rid of the acne; but, excessively dry skin actually makes acne worse (ugh!). Your face needs to be clean and moisturized–not dry and irritated. My favorite moisturizer is Philosophy Hope in a Jar. Every time I use a different moisturizer, I regret it and end up going back to Hope in a Jar. It is another one of my must have products. Yes, it is expensive. Very expensive. More expensive than it should be. But it is worth it. You only need a tiny bit, so a little jar can last for a very long time. If you want to give it a try without buying a large container, search for sample/travel sizes. You can also visit Sephora or Ulta and request a sample to give it a whirl. If you have found another moisturizer that works well–please share in the comments!
- Wash your face well before you go to bed. The easiest way to do this is to shower in the evenings. If that doesn’t work for you, do your best with a washcloth to get the makeup, dirt, and oil off before you go to bed. Might as well get all that stuff off rather than letting it sit on your face for another 8 hours!
- When things get really out of control, I use a tiny dab of Tazorac cream. I used to use Tazorac on a regular basis, but I found that it was making my face too dry and flaky. Plus, it is a pretty expensive medication and my insurance coverage changed which meant I would have to foot the majority of the bill for it. So, now I just use a little dot of Tazorac on the worst spots every few months. Use it very sparingly! A dot about 1/2 the size of a pea should be enough for your entire face. If you use more than that, your face will look like it encountered a chemical spill. Don’t ask how I know that.
Do you have other tips? If so, please post a comment below with your strategies for success with acne. I’d love to hear from all of you! Let’s learn together.
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