Polycystic ovarian syndrome (PCOS) & ACNE

All cases of acne have their roots in hormone production, but some acne is a symptom of an underlying hormonal condition that can cause far more than facial blemishes. If troublesome blemishes are plaguing you long after your teen years are over, it’s possible that they’re telling you to look beyond your skin for the problem.


Acne is caused by an excess of oil production, which in turn is caused by the action of testosterone. The oil glands are the most testosterone-sensitive tissue in the human body. 


Typical adolescent acne starts when testosterone levels start to increase during puberty (in both boys and girls), but certain diseases and conditions can also send testosterone and estrogen levels up. These are particularly common in girls and women, and the most common is polycystic ovarian syndrome (PCOS).


The most common female endocrine disorder, PCOS affects between 5%-10% of all women. It involves multiple organ systems, and although it’s not fully understood, doctors believe that it is caused by insensitivity to the hormone insulin. In addition to irregular menstrual cycles and ovulation, weight gain, and thinning hair, one of the most notable symptoms of PCOS is acne.  


PCOS-related acne tends to flare in areas that are usually considered “hormonally sensitive," especially the lower third of the face. This includes:

• Cheeks
• Jawline
• Chin
• Upper neck, especially at the angles of the jaw

Patients with PCOS tend to get acne that involves more tender knots under the skin, rather than fine surface bumps, and will sometimes report that lesions in that area tend to flare before their menstrual period. They take time to go away.

So if you tend to get acne in the places Schlosser describes and have noticed irregular periods, it’s a good idea to ask your dermatologist to refer you for PCOS testing.

There are some other hormonal disorders whose symptoms can include acne, but these are much more unusual. For example, people affected by a group of inherited disorders known collectively as congenital adrenal hyperplasia often produce either too much or too little of certain sex hormones, including testosterone. People with these disorders have a problem with the adrenal glands, which produce and metabolize hormones.