Acne is a common symptom of PCOS. It is an inflammatory skin disorder that involves interactions between hormones, hair, sebaceous (oil-secreting) glands and bacteria.
Women with polycystic ovarian syndrome are susceptible, possibly due in part to excess levels of androgens (male sex hormones) in the skin. Teenagers are also susceptible around the onset of puberty due to an increase in the production of androgens. This androgen, a metabolite of testosterone, is called "DHT" (dihydrotestosterone).
It is thought that DHT stimulates the production of "oil", which eventually can lead to clogged glands or pores. Clogged pores can no longer release oil and allow bacteria to grow and multiply in the follicle, leading to inflammation.
Enzymes from this bacteria breakdown triglycerides in the sebum (oil) to form "free fatty acids" that further irritate the follicular wall. Rupture of the follicle, accompanied by the release of free fatty acids, bacterial products and keratin, results in an abscess that heals with scars in severe cases.
It can be caused or exacerbated by a combination of factors:
Diagnosis is based on the presence of comedones (pimples) and lesions at various stages of development. Left untreated, it can lead to both scarring and abnormal pigmentation.
It can be caused or exacerbated by elevated androgen levels. Androgen disturbances should be suspected when female adolescents have severe acne or when it persists into adult years, particularly when accompanied by other androgen-related effects such as hirsutism, infertility and weight problems.
If you have acne, hirsutism, or hair loss, these tests would be helpful in diagnosing the cause of your problems: serum levels of testosterone, DHEAS, LH, FSH, prolactin, cholesterol, triglycerides, and thyroid hormones. A two-hour glucose tolerance test with accompanying insulin levels should also be done.
Many PCOS women will have abnormal levels of one or more of these tests, although normal values do not rule out a diagnosis. Once your hormone imbalances are identified, the appropriate treatment can be recommended.
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El-Akawi Z et al, Does the plasma level of vitamins A and E affect acne condition?, Clin Exp Dermatol, 2006; 31(3): 430-3.
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