The PCOS & Acne Connection

We often think of acne as a skin problem, but it’s really a hormone and inflammation condition. High testosterone levels plus inflamed skin lead to excess oil and an altered skin microbiome.

Our skin microbiome is the collection of bacteria that reside on our skin and protect it. The result is oily, inflamed skin covered in unfriendly bacteria - a sure recipe for acne. This includes pimples on the surface and deep cystic acne.

PCOS is a syndrome, not a disease; because it is diagnosed by identifying a specific collection of symptoms and ruling out other potential causes.  It is a systemic, whole-body disorder that affects metabolism, the immune system, the cardiovascular system, the gut, skin, the mind, and truly the entire body.

At it's core it is a rhythm problem, meaning the hormones don't rise and fall properly within a 24 hour day or cycle properly with each month. PCOS can express with many symptoms including abnormal periods, painful periods, clotting, abdominal pain, insulin resistance,high blood sugar, high A1C, high cholesterol, weight gain, stubborn belly fat, anxiety, sleep disorders, infertility, heart disease, acne, facial hair, alopecia, miscarriage, obesity, skin tags, gingivitis and IBS.

If gone unchecked, PCOS can lead to Autoimmune disease, cancer, cardiovascular disease, diabetes, fatty liver disease, mood disorders and pregnancy complications.
 

This condition is caused by a simple hormone irregularity that cascades into an incredibly complex condition.

This hormone irregularity is an issue with aromatization; the body's process of converting androgens (testosterone) to estrogens. This process is initiated by the enzyme aromatase which is created in the ovaries (along with testosterone, also created in our ovaries!). When the testosterone meets aromatase, it is supposed to convert to estrogen.

Though most estrogen aromatization takes place in the ovaries, the brain, gut, uterus, lungs and fat cells also make aromatase and convert androgens into estrogen because we need estrogen all over our body.  This broken process causes women with PCOS to generally have lower than normal estrogens. Our brains sense this estrogen deficiency which then signals the body to make more testosterone with the intention that it will be converted.

So the body is making more testosterone but the estrogen production never quite catches up. This excess testosterone can actually damage estrogen receptors. In women, there are of course estrogen receptors in our vagina, uterus and breasts, but estrogen is not only a reproductive hormone.

There are also estrogen receptors in the brain, the lining of the colon, the liver, and on both fat and immune cells. The cells in the pancreas that produce insulin also have estrogen receptors. Without estrogen, these cells cannot properly respond to blood sugar levels and produce the correct amounts of insulin.

It is important to work with a practitioner who properly knows how to recognize the hormone profile and symptoms of PCOS, and also someone who understands the severity of this. You may be seeing someone for your anxiety and an OBGYN for painful periods but not put the puzzle pieces together to understand that you are suffering from ONE condition that is causing ALL of your symptoms.
 

Many topical acne systems aim to “kill” the bad bacteria on the skin’s surface by the use of drying and anti-bacterial chemicals.

The problem with this is two-fold; for one it kills the good with the bad and so instead of balancing the skin's microbiome we kill it completely while drying and damaging the skin in the process.

Two, it does not address the root cause of the issue meaning we are not really healing or resolving anything - just putting on a temporary bandaid. Going on birth control is another “solution” that many young women turn to when they’re young and have acne along with painful period symptoms. This, again, is only a temporary bandaid to a problem that will let the disease process continue, unchecked, for many years. 

In order to have the most accurate data on your body, we suggest working with a practitioner that uses a hormone saliva test or DUTCH test (dried urine), rather than blood. You should also have an ultrasound done of the ovaries; which may - or my not - show cysts.

You can still have PCOS without the physical manifestation of the cysts as sometimes these don’t develop until years down the line. These cysts are actually developed follicles and evidence of a broken ovulation process.  

When working on healing PCOS naturally there are 3 goals: 

 

1) Reduce Inflammation 

2) Normalize hormones and rhythms 

3) Increase Insulin Sensitivity

 

Inflammation and PCOS

The body treats chronic conditions like PCOS as chronic injuries which means chronic inflammation. Instead of your body healing, the inflammation makes you sick. It causes diabetes, heart disease, weight gain and cancer.  

Hormonal rhythms & balance

Hormones are chemical messengers that tell your body what to do and when to do it. In PCOS, your hormones don't cycle up and down properly within a 24 hour day; this causes anxiety, sleep disorders, infertility and weight gain.  

Insulin sensitivity

Insulin sensitivity is your body's ability to see and respond to insulin, a hormone that regulates blood sugar. PCOS makes you insulin resistant which means your body can't react to insulin and your blood sugar fluctuates more than it should. This is the same condition that leads to diabetes *type 2.

Additionally, insulin resistance causes inflammation and heart disease. It raises your testosterone levels, which causes acne. It also keeps your body in fat storage mode so you perpetually gain weight and never burn it. 

The information provided here is based on Dr. Felice Gersh, M.D. and author of PCOS SOS - a wonderful book that is a recommended reading for any women with PCOS. It can be purchased on Amazon.

Whether you are a customer with acne or an esthetician who services clients with acne, it is incredibly important to understand if there is a possibility of PCOS. Understanding this as a root cause of many symptoms will help in your journey to both understanding and healing your skin condition.