Episode #32: PCOS and Acne

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The elevated testosterone found in most women with PCOS often leads to adult female acne. This isn’t the small little pimple here and there, this is usually very deep, large cystic acne that can persist for weeks at a time, leaving behind discoloration and scars. In this episode, we are going to cover regimens exactly what to do to balance your hormones, but also what products and regimen I recommend for women with polycystic ovarian syndrome acne. So let’s get started.

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You’re listening to the PCOS Repair Podcast, where we explore the ins and outs of PCOS and how to repair the imbalances in your hormones naturally with a little medical help sprinkled in.

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Hi, I’m Ashlene Korcek and with many years of medical and personal experience with a polycystic ovarian syndrome, it is my joy to watch women reverse their PCOS as they learn to nourish their bodies in a whole new way. With the power of our beliefs, our mindset, our environment, and the understanding of our genetics, we can heal at the root cause

[00:01:17.430] – Speaker 1

Welcome back to the PCOS Repair Podcast, where today we get to talk about PCOS and acne and how to go about balancing your hormones for clearer skin, as well as what products, medications, and other recommendations to assist you in treating your acne. So first, why do women with PCOS break out like teenagers? Well, let me rephrase that. Break out worse than teenagers. PCOS, acne, or adult hormonal acne is deep cystic, long-lasting acne lesions that can cause scarring and discoloration, as well as, can be very uncomfortable and painful. So the big reason why this happened is that your hormone imbalance of elevated androgens in specific testosterone can lead to increased oil production. The medical word for that is sebum and increased cell production, leading to a build-up in the cell. Also, with PCOS, we tend to have a higher state of inflammation in general and we are more prone to inflammation and so then you get this excess oil, excess cell build-up, and inflammation creates this cystic lesion. So as we think about reversing those couple of things, clearly, if we started to improve our hormone balance, we would see an improvement in our acne.

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So just to be aware, it can take several months for your acne to calm down when taking a natural approach to it. In addition, skin care can really benefit from a good clean regimen. And we’re going to go over what I recommend for women with PCOS in this episode. But first, I want to talk a little bit about what your doctor or doctors, depending on who you’re seeing, may recommend for acne in specific adult female hormonal acne. Okay, so if you’re seeing Ob-Gyn or your family practice, their go-to is usually birth control. Now, the problem with birth control for acne is one, I rarely see it to be very effective, and two, as soon as you come off of it, you have rebound acne and it’s very difficult to get it back under control even if you go back on birth control because birth control can take several months to level out your hormones, especially when it comes to acne. So I know we’ve talked about birth control and PCOS and other episodes in regards to your cycle and all sorts of things like that, but when it comes to acne, I see it cause a lot more havoc and chaos and headache when it comes to acne and cysts than it helps.

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But to each their own if you want to try it, go ahead. You’ve been warned. I’m kidding. But not really. When it comes to a dermatology office which is what I did for many years and where I first started seeing women with PCOS, it was helpful in the short term to maybe do a month or two of antibiotics. Now, I don’t highly recommend this but if you are so frustrated with your acne, if you are getting really painful lesions, if they are leaving scars, antibiotics in a low dose such as doxycycline are going to help reduce that inflammation quicker and you’re going to see a quicker result than other things that we can give you. I do not recommend staying on it long-term. I have seen many women come to me who had seen other doctors that had put them on a long course like years of antibiotics. A couple of things with that one, if you’re above a certain dosage you’re going to develop resistance. There are some studies that show if you have a low enough dose, you reduce your risk of resistance, but it’s still there in my opinion, meant to be a one to two-month band Aid to get you over the hump while we let other treatment options start working.

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The other issue I have with long-term antibiotics, especially at a normal dose for antibiotic purposes, is that you’re going to really upset your microbiome which is all of the natural microbes and bacteria that we want to have, the good bacteria that we want to have in your gut this is going to also increase inflammation. So if you mess up the microbiome, you’re going to increase your inflammation. So being on an antibiotic for the short term and doing everything you can to care for the normal flora in your microbiome is something that if you are struggling with acne if you are getting scars, it is not wrong to do. But I want you to understand the side effects, okay? The best treatment that I like for longer-term care of acne, especially well, of course, you’re getting your lifestyle and hormone balancing underway as well, which we will also talk about is a topical treatment. Now, there’s one called AXone that I liked a lot for my patients with adult female hormonal acne. I felt like it was really helpful with really low side effects and not a lot of dryness or irritation to the skin. So you can talk to your dermatologist about that.

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It is a prescription. The other thing that I really like is some sort of retinol. So there are over-the-counter retinol all the way to very strong prescriptions of retinol and those are both antiaging as well as assisting with acne. Now insurance, why is I did run into some situations with insurance not covering it for women over a certain age because like over like 25. Like I’m not talking very old like they stopped covering it because of course adult women don’t break out. We’re just using it for antiaging. And so it’s cosmetic right? So I could fight that. I could try to explain that no, we actually are treating acne, but sometimes you run into problems with that. The other part of retinals that I think is really important to mention is that it makes you very sun sensitive. So you want to be very diligent with your sunscreen if you’re going to be outside so you’re not getting burned. And it also can be kind of drying and irritating to the skin. Stronger is not necessarily better. What you want to do is find your sweet spot of strength and you can actually start with an over-the-counter one called Different.

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That is very, very good. It’s the one I use every night and work up to it every single night. You may start with using it two or three times a week and you don’t put very much like this is not like a moisturizer where you’re caking it on. You’re using the size of a pinky nail on your entire face and putting little dots around and then spreading it in carefully, not too close to the corners of the mouth, not too close to the crevices of the nose, and not right around the eyes. Okay, so there you go. That’s the old spiel that I would give patients in the clinic. But that one can be very helpful in reducing oil production, increasing how quickly your skin cells regenerate. That’s why it’s anti-aging. But in increasing how quickly your skin cells regenerate, it moves things along and it decreases the build-up in your pores. In the beginning, you may actually see shedding like your skin may be a little flaky, but once that clears up, it is still doing that at a micro level. It’s just not drying you out as much because your skin gets used to it and it becomes less irritated as your skin gets used to it.

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Okay, so then that’s really all you need to do as far as medication. You could literally just do differently at night a couple of times a week and that would really help your acne from a medication standpoint. Then of course you want to have a really gentle cleanser. You don’t need to strip all your oils away. If you strip all your oils away with a heavy-duty cleanser, you are actually going to increase your oil production. So this is a weird thing that happens when your body thinks it needs that much oil. And if you reduce the oil by trying to dry out the skin too much with cleansers and so forth, your body will actually counteract that by just producing more oil. So a really gentle cleanser is all you need morning and night and then a good moisturizer. Ideally use it in the morning or the nights that you’re not using your retinol or your retinoid because they actually don’t play all that nice together. It kind of deactivates your retinol and then you’re spending money on something that’s not working as well. So another little tip there. And then if you want to take it a step further, you know how we were talking about kind of this build-up on the skin and the oils and all of this is I love, my favorite is a glycolic peel.

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So you can actually get over the counter these little premedicated pads that are 20% glycolic. You can actually get lower percentages, but I like the 20% ones. You could work up to that with 10% and then move on to 20%. I will link to this on the episode page on the website so you can go and you can see all the different skincare regimens that I use and recommendations and how I use them and all of that. But if you get these premedicated pads, I use my 20% one once at the most twice a week. Okay. And I will just wipe my full face down maybe a couple of minutes before I’m going to get in the shower. Water will deactivate the glycolic. So if you start to feel like it’s too stingy, then you can just rinse it with water and that will deactivate the glycolic. But this level of a glycolic peel is a lot less than you would get from an esthetician. It’s not going to turn bright red for a couple of days. It’s not going to have a drastic peel. You may be slightly pink for a few minutes while doing it or while it’s on your skin, or a few minutes following, but it’s not going to be something that lasts for two or three days.

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But it is really helpful because it’s going to give you a little bit of exfoliation without any scrubbing. You really want to avoid scrubbing because you’re already dealing with inflammation here. And so scrubbing is just going to inflame and irritate acne-prone skin. You can also get these premedicated pads with salicylic and glycolic. Two things of note here, salicylic is not recommended for women who are pregnant. So if you are trying to get pregnant, I would stay away from salicylic. And if you are already a little sensitive. So if your skin tends to be on the sensitive side or you’re not oily, salicylic is going to be more irritating and more drying than glycolic on its dome. And aside from that, then the lifestyle changes. We’ve talked about these in episodes one through four quite a bit. So if you want to go back and refresh yourself on those, go back and listen to those episodes. But as you balance your hormones, your acne becomes easier and easier and easier to manage. So last thing I want to mention is something called Spironolactone. So that is my typical acne regimen for women with PCOS.

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Okay? To recap, gentle, cleansing, a good moisturizer, this is going to be something that is non-fragranced for the face, a cream, and a lotion, if it’s during the day, ideally has a little bit of physical blocker SPF. So that’s going to be zinc or titanium SPF. And then you’re going to consider using retinol. At night, you can get an over-counter different, it’s a 1% gel. And then if you want to take that a step further, you can get a premedicated glycolic or combination glycolic, salicylic acid, little like pads. I will link to those on the website for this episode. The ones I use are 20%. I wouldn’t go higher than that unless you are a licensed esthetician. Okay. And then the last thing I want to talk about is the more extreme medications that you can get from your doctor that are a little longer term. So the first one is Spironolactone or Aldactone. This is actually a medication for blood pressure and heart disease. But we found that it blocks the androgen on the skin cells, so it can reduce acne. Some people find that it improves the loss of hair and so women with PCOS are often offered a prescription for Spironolactone.

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I have seen it work extremely well for patients. Some patients just do not tolerate it well. But it’s either like people do great with it or they just really don’t like it. If your doctor recommends it to you, it’s completely up to you. Again, this is one that you do not want to take if you’re thinking about getting pregnant. It’s not safe if you’re pregnant. So if you’re currently trying to get pregnant, then avoid that medication then. If you have always struggled with acne and it has only worsened as you have become an adult, your doctor may talk to you about accutane. Now this one definitely does not mix with fertility or trying to get pregnant. It can lead to serious birth defects. And so you want to make sure that if you’re taking it, you are on other forms of birth control, that you are definitely not going to get pregnant while on the medication. But if acne is your primary concern at the moment, it can be something that you can explore with your physician. It is usually a six-month treatment and it has longer-lasting results when it comes to acne treatment it can be drying, irritating, and you’re going to be really, really dried out, like really chapped lips kind of dried out. But if acne has been a concern for a long, long time, then it may be something you want to consider but only certain doctors prescribe it so you have to find a doctor that does prescribe it, and there’s a whole regimen that they have to follow if they go down that road. But I did want to mention those too because that was not necessarily a go-to for me with women with PCOS or adult female hormonal acne but if they’ve been struggling with it for years and they’ve done all the other things and it’s just not getting them the results they want, it is something to consider. It’s amazing how the pain of cystic acne, the appearance, and the decrease in confidence that comes along with acne, it can be definitely worth figuring out what is needed to get your acne under control. So those are some of the recommendations that I have for when it comes to acne. So there you have it, my friend, as a quick recap, balancing your hormones, the benefits of that when you take a natural lifestyle approach to balancing your hormones just keep giving.

[00:14:49.800] – Speaker 1

We’ve talked about many other of the PCOS symptoms on the PCOS repair podcast and skin is just one more of the areas where taking that lifestyle approach, nourishing your body and caring for your body in a way to make sure it’s getting the nutrients it wants, make sure it’s getting the movement that it needs, make sure that you are caring for it on an emotional and stress level. All of those things are going to improve your acne as well but there are also some great things that you can do for your skincare regimen, a nice gentle cleanser, retinol for both acne control as well as it has antiaging benefits, and finding yourself a good moisturizer using a good sunscreen during the day and if you want to take it to the next level, including a glycolic low percentage like 20% premeditated pad that you can use to wipe your face down and treat your skin with to help reduce your acne as well. So there you have it. This is how I recommend treating acne in regard to PCOS and I hope that you have found this episode helpful. If you have, please tap that subscribe button on your favorite podcast listening platform so that you get notified each and every week when your next dose of PCOS health is released.

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And until then, I would love to continue this conversation further with you on Instagram. You can find me at Nourished to Healthy and I look forward to chatting with you further over there. Until next week. Bye for now.

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Did you know that studies of PCOS epigenetics have shown that our environment can either worsen or completely reverse our PCOS symptoms? I believe that although PCOS makes us sensitive to our environment, it also makes us powerful. When we learn what our body needs and commit to providing those needs. Not only do we gain back our health, but we grow in power just by showing up for ourselves. This is why I’ve created a guide for you to get started.

[00:16:44.670] – Speaker 2

My PCOS Fertility Meal Guide can be found in the show notes below. I want to show you how to create an environment that promotes healing while still being able to live a life that you enjoy. This guide is completely free, so go get your copy now so that you can step into the vision that you have for your life and for your health.