PCOS and Acne Treatment

Acne is a common symptom of polycystic ovary syndrome. It is an inflammatory skin disorder that involves interactions between hormones, hair, sebaceous (oil-secreting) glands and bacteria.

If you have PCOS or insulin resistance, here are some acne treatment options to consider.

Conventional Treatment of Acne

  • Oral or topical tretinoin or isotretinoin (retinoic acid, Retin-A, Accutane). Oral tretinoin should only be prescribed by a physician who thoroughly understands its adverse effects. Pregnancy testing is important prior to beginning tretinoin therapy and at monthly intervals, due to the risk of severe fetal abnormalities that can occur if pregnancy results while taking this drug. Its acts by unplugging acne follicles and bringing acne pimples (comedones) to the surface. This is why tretinoin makes acne look worse in the first few weeks of treatment.
  • Over-the-counter topical preparations containing benzoyl peroxide (Benoxyl), which is an anti-bacterial agent.
  • Over-the-counter topical preparations containing sulfur (Clearasil, Acnederm), which is a keratolytic (peeling agent) and also helps suppress the growth of bacteria.
  • Topical agents containing azelaic acid (Skinoren Cream, Azelex, Finevin). Azelaic acid exerts an antibacterial effect. It is also keratolytic and has a therapeutically positive effect on the formation of comedones (blackheads, whiteheads).
  • In severe cases, the antibiotics tetracycline or minocycline may be used. Antibiotics are anti-bacterial agents.
  • Increased exposure to sunlight or ultraviolet light (such as tanning beds).
  • The ClearLight system, which uses a narrow-band, high-intensity light known as blue light to attack the bacteria in pimples. Available from some dermatologists.
  • In the case of women with PCOS and acne, physicians will typically prescribe spironolactone (Aldactone) and birth control pills. Some birth control pills (e.g., Orthotricyclen, Orthocyclen, Desogen, and Demulen) contain lower levels of androgens and should, at least theoretically, provide better acne control.

Natural Treatment of Acne

General Recommendations

  • Avoid using drugs that may cause acne.
  • Avoid exposure to oil or grease.
  • Use hypoallergenic cosmetics and soaps if available.
  • Wash the affected areas thoroughly twice daily, or more if needed, to remove excess oils.
  • Wash pillowcases and sheets regularly in chemical-free (no added colors or fragrances) detergents.
  • Get adequate sun exposure.

Dietary Guidelines

  • Eliminate refined carbohydrates and sugars from the diet.
  • Avoid eating foods containing trans fatty acids (such as milk, milk products, margarine, shortening), partially hydrogenated vegetable oils, and fried foods.
  • A healthy diet, as described in The Natural Diet Solution for PCOS and Infertility, is crucial for improvement of all PCOS symptoms, not just acne.

Nutritional Support

  • Zinc (50-75 mg daily): Zinc decreases the conversion of testosterone to its active form (DHT), thus reducing the stimulatory effects on oil glands. Other important functions of zinc include wound healing, immune system activity, tissue regeneration, and control of inflammation. In a study published in the British Journal of Dermatology, zinc was found to be equally as effective as oral antibiotic therapy in the treatment of acne. Results may take up to twelve weeks for results to occur.
  • Saw Palmetto (50 - 200 mg daily): Saw palmetto is also well known for its ability to inhibit the conversion of testosterone into DHT.
  • Vitamin A (25,000-50,000 IU daily - if you are not pregnant or planning on becoming pregnant): Vitamin A has been shown to reduce sebum production and the build-up of keratin in the follicle. The dosages required for this effect are relatively high (300,000-400,000 IU daily for up to six months) and potentially toxic. If you use a micellized (water soluble) form of vitamin A, you may be able to mitigate the toxicity somewhat. However, we recommend you consult with a naturopathic or other physician if you wish to take over 25,000 IU of vitamin A. You may be able to take less vitamin A if you're also taking other nutrients such as zinc and vitamin E. For sexually active women of childbearing age, do not take more than 5,000 IU daily unless an effective form of birth control is being used, or unless you are under the supervision of a physician.
  • Vitamin B6 (50-100 mg daily): Plays a role in the normal metabolism of steroid hormones. Vitamin B6 deficiency in rats has been shown to cause an increased uptake and sensitivity to testosterone.
  • Pantothenic acid (2.5 grams four times daily for a period of two weeks): Plays a role in fat metabolism and has been shown to be of value in the treatment of acne at high doses.
  • Vitamin E (400 IU daily): Is vital to the functioning of vitamin A and the activity of selenium. During a vitamin E deficiency, blood levels of vitamin A stay low regardless of the amount of vitamin A consumed. However, when vitamin E is added to the diet, blood levels of vitamin A will normalize.
  • Selenium (100-200 mcg daily): This antioxidant trace mineral functions in the enzyme glutathione peroxidase. Selenium is important for preventing the inflammation associated with acne. Individuals suffering from acne have been shown to have reduced levels of glutathione peroxidase. Following treatment with selenium and vitamin E, glutathione peroxidase levels significantly increase, while the severity of acne typically decreases.
  • Essential fatty acids (EFAs): These fats have the ability to reduce inflammation and may be of benefit in treating acne. One tablespoon of either fish oil or flaxseed oil may be helpful. Consumption of cold water fish like salmon and mackerel are other good sources of anti-inflammatory fats. You can also obtain concentrated fish oil in convenient capsules.
  • There are other nutrients that may be helpful for acne and other symptoms of PCOS. The above is only a partial list. Consult with a naturopathic physician for a customized nutrient program.

Topical Agents

  • Tea tree oil (10-15% preparation): A 1990 study compared the topical use of tea tree oil (5% preparation) to benzyl peroxide (5% preparation) in the treatment of common acne. Although the tea tree oil took longer to work and was less potent in action, it had far fewer side effects and was thus considered to be more effective overall. Tea tree oil should not be applied to broken skin or to areas affected by rashes.
  • Azelaic acid (apply cream to affected areas twice daily for at least four weeks): This naturally occurring acid has been shown to have antibiotic activity against acne bacteria. Studies using a 20 percent azelaic acid cream have shown that it produces results equal to those achieved with benzyl peroxide, Retin-A or oral tetracycline in the treatment of many different types of acne. Given its low incidence of side effects and allergic reaction, azelaic acid may be a safe alternative to many conventional drug therapies. However, you may find it irritating to the skin.

Note: Your genetic predisposition and health status is unique to you. If you have PCOS and acne, a treatment that works for you may not work for someone else, and vice-versa. Therefore, you will have to do some experimentation to find the right combination of diet, lifestyle, supplements and medications that will diminish your acne and other symptoms of PCOS.

Latest Research News

In a study involving 100 people who were recently diagnosed with acne and not treated and 100 age-matched healthy controls, low blood concentrations of vitamin A and vitamin E were found among subjects with acne.(7) Furthermore, it was found that the greater the severity of acne, the lower the plasma concentrations of vitamins A and E.

This study suggests that low levels of vitamins A and E may contribute to the pathogenesis and aggravation of acne. You can get vitamin A and E by eating a variety of fresh whole foods. Processed "convenience" foods will be much lower in these nutrients.

An easy way to make sure you get enough vitamin A and E is to take a high-quality multi-vitamin supplement. (Most supplements have beta-carotene, which is converted by the liver into vitamin A.)

More Information about Acne

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