Acne Problem and PCOS



Women with PCOS have been finding ways to deal with Acne. Acne goes hand in hand with PCOs. In more than 20% of PCOS women, Acne is the first symptom that leads to the diagnosis. Acne is embarrassing and painful with distress and low self-esteem afmong younger women with PCOS. Acne is a skin condition with eruptions on the skin. They look like cysts and in extreme conditions may be inflamed and appear like skin rashes. It normally forms in parts of the skin abundant in sebaceous glands. Sebaceous glands are present within hair follicles and secrete sebum, a lubricant that moisturises the skin. Skin areas of the face, back and upper part of the chest with more sebaceous glands are prone for Acne. In PCOS, Acne is more common in areas of the skin on jaw line,cheeks, chin and neck that are more sensitive to hormones. Unlike Acne in other conditions which open up on the skin, Acne in PCOS form as tender knots under the skin that take longer to disappear.

Factors that contribute towards the formation of acne are :

-        pores can get blocked by dirt and dead skin cells that accumulate and fail to shed away.
-        Skin infection by certain bacteria that block the pores can cause Acne.
-        High Testosterone levels in PCOS can trigger hyperactivity of sebaceous glands to produce excess sebum and Acne.
-        General inflammation as a secondary symptom of another underlying medical condition or medicines can also be the source of Acne in PCOS.
-        Behavioural habits such as not having a wash regularly, not drinking enough water and using cosmetics.
-        Consuming excess of junk food, fried food, sweets and chocolates are also known to increase sebum secretion and Acne. 

It is important to note that though Acne is a worrying symptom, it is not the only symptom of PCOS. Best therapy to get rid of acne may include treatments for other symptoms as well. Treatment options for Acne in women with PCOS are to be discussed with a Gynaecologist to seek best quality health care. To prioritise what is most important to be treated has to be communicated to the doctor. The gynaecologist, after complete examination will recommend the best suitable treatment. There are tried and tested ways to deal with Acne in PCOS. Treating the underlying hormonal imbalance has been the most effective. One or more medications, depending on the symptoms may be prescribed by the gynaecologist.

Managing Hormonal Levels

  • Hormonal Contraceptive pill combinations taken throughout the menstrual cycle can help maintaining hormonal balance to control Acne. The mode of action is that they reduce Testosterone and other Androgens produced by Ovaries and increase the body's production of sex hormone binding globulin (SHBG).  SHBG is a protein usually present in very low amounts in PCOS. This SHBG functions in binding with Testosterone and reduces free circulating Testosterone. Growth of Acne is associated with the levels of free Testosterone in the body and not those that bind to proteins. By increasing SHBG levels, the pill reduces the activity of free Testosterone and thus reduces the symptoms of androgen excess causing Acne in PCOS.
  • In severe cases of Acne, Antiandrogen drugs in short specified courses, in addition to the hormonal contraceptive pills may be suggested. These drugs, either bring down the level of Androgens being produced, blocks androgen activity or reduces the binding of Testosterone to target tissues prone to Acne.
  • High levels of Insulin are known to increase Androgen levels in the body. There are Insulin sensitising drugs that can help with reducing symptoms of Acne. They have similar effects as hormonal contraceptive pills but with less side effects and comparatively safe on prolonged use.
Dermatological treatments

Face creams, gels or lotions that reduce pore blocking, oil production by the skin and inflammation can be used to treat Acne. Severe Acne can also be treated by Dermatologist prescribed medications that shrink sebaceous glands and prevent sebum production in the skin. These drugs are only for women who do not wish to conceive and are strictly prescribed alongside effective contraceptive pills. They are popularly known as Retinoids and can be taken orally or applied as a topical cream or gel. For PCOS-related Acne, Retinoids that are available over the counter (OTC) are not recommended. Dermatologist prescribed Retinoid dosages need to be progressed gradually depending on how the skin reacts to the medication. Retinoids make the skin extremely sensitive to sun’s UV rays, so it’s important to apply sunscreen liberally throughout the day. Unprotected skin is high risk for hyperpigmentation and skin cancer. This medication is more popular among teens with PCOS.

Diet & Lifestyle
Diet may not be the only cure for Acne in PCOS but incorporating a PCOS diet is avital part of an overall treatment plan in PCOS. Inclusion of anti-inflammatory foods in everyday diet can be a good modification that supports clearance of Acne. Anti-inflammatory foods include spinach, tomatoes, walnuts, almonds, olive oil, salmon, turmeric and berries. Foods such as red meat, refined products, potatoes & tubers and sugary foods like beverages and sweets, have an inflammatory tendency and so can be better avoided in regular diet. Dairy foods are also known to exacerbate Acne, hence can be avoided.

Exercise and physical activity with the objective of loosing weight can bring down Insulin levels in the bodyand thereby reduce Acne in PCOS. Aerobic exercises contribute towards better skin care by opening pores and allowing the skin to breathe better. Overall health improves with look good, feel good attitude.

Supplements
To manage inflammation and Acne, supplements may be considered. Zinc, Bromelain,copper, Vitamin A, Vitamin C and Vitamin B6 are commonly recommended as additional antioxidants to defend against Reactive Oxygen Species (ROS) in stress conditions of PCOS. They control inflammation and skin eruptions in a more passive and sustained mode.

Skin Care Tips
A skin care routine involving simple care and effort can be very useful in maintaining skin health. Following are some skin care tips:
-        Washing the face twice daily with a mild soap.
-        Gentle scrubs with natural ingredients can help exfoliate dead skin.
-        An oil-free moisturizer suitable for the skin type is recommended.
-        Avoid picking and scratching blemishes.
-        Use noncomedogenic cosmetic makeup only.

Acne is not the only PCOS symptom to deal with. Doctor needs to be informed about any new or unusual symptoms to facilitate change in treatment plan and better suit timely needs. It is recommended to follow a step by step follow up treatment to better overcome PCOS as per required symptom relief and reduce suffering from Acne. Women who are highly disturbed by their Acne affected appearance, may need counselling along with family and social support to protect from emotional break down and depression.

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