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Treating acne in PCOS

Acne is a skin condition that happens when hair follicles under the skin become clogged. Sebum, the oil that helps keep skin from drying out, and dead skin cells, both of these plug the pores, which leads to outbreaks commonly called pimples or zits. Most often, the outbreaks occur on the face but can also appear on the back, chest, and shoulders. Various types of acne include fungal, cystic, hormonal, and nodular acne. Out of these, hormonal acne is mostly associated with PCOS.
Studies have found a prevalence of 17% to 27% of women with PCOS suffering from acne.
Normally, the sebaceous glands make sebum (oil) that empties onto the skin surface through the opening in the hair follicle or pores. Keratinocytes are a type of skin cells that line the follicle. Usually, as the body sheds skin cells, the keratinocytes rise to the surface of the skin. But when someone has acne, the hair, sebum, and keratinocytes stick together inside the pore thereby clogging them.
Acne has a considerable impact on quality of life. The impact is proportional to the severity of acne. More severe acne is associated with a greater effect on quality of life with implications for self-esteem, body image, and relationships with others. (Eleni Tasoula et al.)

Why do women with PCOS are prone to acne?

  • Women suffering from PCOS usually suffer from increased levels of male sex hormones like androgens (eg. testosterone) in the body, commonly referred to as Hyperandrogenism. The prime cause being – Insulin Resistance and Hormonal imbalances.
  • Normally, the ratio of Leutinizing hormone (LH) to Follicle stimulating hormone (FSH) i.e. ratio of LH: FSH is well balanced. But in PCOS, however, the levels of LH increase and FSH gets depressed.
  • On the other hand, Insulin Resistance develops due to improper utilization of insulin and thus leads to Hyperinsulinemia. These high levels of insulin along with high levels of LH enhance the production of androgens like testosterone and thus lead to Hyperandrogenism.
  • Peripheral 5α-reductase activity also increases. This is the enzyme that converts testosterone to dihydrotestosterone (DHT), which amplifies androgen action. These androgens also serve as substrates for sebaceous gland enzymes. Increased sebum production correlates with the severity of clinical manifestations of acne.
  • Hyperandrogenism favors the development of acne by increasing sebum production but mainly by altering the sebum lipid profile (Carmina E. et al.).This alteration in the sebum profile thus induces cutaneous (skin) dysbiosis which further leads to hyperkeratinization, inflammation, and acne, accelerating the follicular damage.

How can you treat the acne?

Commonly, treatment comprises applying anti-acne creams and taking certain oral medications like antibiotics. But in the case of hormonal acne, as seen in PCOS, it does not always respond to the standard treatment medications. The hormonal imbalances thus, shall be addressed while treating this kind of acne.
Following are some solutions to treat acne in women with PCOS:
  • The unblemished and immaculate skin requires proper care from inside as well as outside. This could be done by consuming nutritious and healthy food regularly coupled with a disciplined lifestyle.
  • Some ways are exercising regularly, losing or maintaining a normal weight, and eating a well-balanced diet. This would help, aid and lessen the acne.
  • The proper diet should include low carbs (mostly complex), high protein, and moderate fat (omega 3s, MUFAs). Foods high in sugar, salt, saturated, and transfat, processed and packaged foods may aggravate and worsen the acne.
  • OCPs (Oral contraceptive pills) like estroprogestrins or anti-androgens may also be advised for suppressing excess androgens. Metformin therapy is also recommended for addressing Insulin Resistance.
  • Follow a proper skin care regimen advised by a dermatologist and consult them before applying any products and creams.
  • Microdermabrasion is the minimally invasive epidermal resurfacing procedure used to treat uneven skin tone/texture and or acne scars. It involves crystals propelled against the skin under the control of a handheld vacuum system which causes gentle mechanical abrasion to the skin, which ultimately removes the stratum corneum layer of the epidermis. As part of the wound healing process, new epidermis forms with enhanced cosmesis (Muneeb Shah et al.)
  • Chemical peeling mostly Salicylic Acid peeling treatment is also suggested by doctors to remove the scars and regenerate the normal skin. However, it should be strictly done under a doctor’s guidance.
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In conclusion, discussing PCOS with your doctor can help you better understand your condition and take proactive steps to manage your symptoms. By asking the right questions, you can work with your doctor to develop a treatment plan that works best for you. Remember to be honest and open with your doctor about your symptoms, concerns, and goals. With the right information and support, you can successfully manage your PCOS and live a healthy, fulfilling life.

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