45. Females only - Acne and PCOS (Polycystic Ovary Syndrome)

Doctor Jacob here, and today we're talking about acne and PCOS. This is a topic for women only.

If you don't know, PCOS stands for Polycystic Ovary Syndrome. It's a syndrome that results from ovaries having small little cysts around their edges and has a constellation of sings, one of which is acne. There can also be excess hair, such as excess facial hair or body hair, a deepening of the voice, as well as infertility issues. Many patients don't have all of these features; some only have the acne and infertility, some have a combination of all those features, so it can be somewhat variable.

Many women with PCOS also have menstrual irregularities, for example a longer cycle or irregular cycles. In this episode we'll talk about the treatment of acne in PCOS patients.

Acne usually is a hormonal acne within PCOS, but can be a combination of both a hormonal acne component and an inflammatory acne component, such as papular acne, pustular acne or even nodulocystic acne, requiring different types of therapies.

So with that in mind, I usually take a look at the acne and treat for both types of acne, hormonal component as well as whatever other component is there. That may be something that's topically, or with some antimicrobial dosing or antibiotics plus birth control pills and spironolactone, or it may be something that I would recommend Accutane plus birth control pills and spironolactone. Accutane is, of course, isotretinoin.

We'll talk about Accutane in a later episode, but I just wanted to mention this PCOS acne should be treated for whatever combination it is. Usually it's hormonal acne plus some sort of inflammatory acne, in many cases. So the treatments have to be a combination treatment.

Many patients I've seen with PCOS type acne end up going on a course of Accutane and following that up with long-term birth control pills and spironolactone. These items can be started at the beginning and can be taken throughout the course of Accutane.

That being said, I do want to mention a drug called metformin. Metformin is a pill often used to treat PCOS when trying to deal with the infertility or the pre-diabetic aspect of the condition. It doesn't cause acne and some dermatologists think that it can help, but I don't think it works so directly. It's not such a thing that I would say, "Oh, you have acne, let me put you on this drug metformin to treat your acne." I would rather treat the acne with more established therapies, such as birth control pills, spironolactone and other topical therapies as needed.

I just wanted to mention that, because you may hear about metformin for acne, and I think it's a good drug and it can be useful in managing other aspects of PCOS, but I wouldn't recommend it specifically for the treatment of hormonal acne related to PCOS. There are other more effective drugs for that.

Of course, the first thing is always to remove any exacerbating factors, so I must mention - although it's been mentioned in previous episodes - glycemic index and acne. High glycemic index diets, which are common in westernized countries such as the United States of America, involve eating refined sugars, sweets, as well as starches such as white bread, white pasta, which can break down immediately into sugars and release a load of sugar quickly into the body. This results in some metabolic abnormalities, because the body is not able to handle this load of sugar over and over and over again. High glycemic index diets contribute to the development of acne, but especially adult onset female hormonal acne, and especially hormonal acne within PCOS. Therefore, I strongly recommend a low glycemic index diet, without too many sweets, without so much white bread, pasta, white rice; more whole grains, low glycemic index fruits and vegetables, proteins and such. I think by making some dietary changes, many women with acne and PCOS do see a good improvement.

That's it for today. I'm Doctor Jacob, we'll see you next time.