Integrative Skincare for PCOS

By Suzanne Fenske, MD, FACOG, ABOIM, MSCP

Pull quotes:

“Consider for a moment that your skin is a doorway to your internal health.”

“From an integrative perspective, we don’t simply want to treat the symptom; we want to peel back the layers to address the root causes of imbalance.”

“Practice patience and self-compassion as you work on each underlying factor. Trust that your body seeks balance and knows how to heal. Your job is to help create the healing conditions.”

Integrative Skincare for PCOS

One of the biggest challenges with polycystic ovarian syndrome (PCOS) is how the syndrome affects your skin. From oily skin and cystic acne to unwanted hair growth, PCOS can take a toll on your self-esteem and confidence.

Consider for a moment that your skin is a doorway to your internal health. Skin issues can reflect internal imbalances, and in the case of PCOS, skin symptoms occur because of the deeper hormonal dysfunction.

From an integrative perspective, we don’t simply want to treat the symptom; we want to peel back the layers to address the root causes of imbalance. With stronger internal health, you’ll notice clearer, calmer, and healthier skin.

Today’s article will explore how PCOS affects the skin and integrative skincare solutions. Keep reading as we connect the dots:

• What is PCOS?
• PCOS and skin health
• Acne
• Hair changes
• Dark spots and skin tags
• Integrative, functional, and holistic tools for PCOS skin health, including root cause approaches and skincare

PCOS Recap

PCOS is the most common endocrine disorder in women, characterized by irregular menstrual cycles, elevated androgens (like testosterone, DHEA, and DHT), and polycystic ovaries. While you only need two of the three of these criteria to qualify for a diagnosis, PCOS typically also presents with other hormonal imbalances, including estrogen dominance, low progesterone, thyroid issues, and insulin resistance.

As many as 70% of women with PCOS have insulin resistance, which creates an environment of high blood sugar and insulin. High insulin drives high testosterone (some consider PCOS to be insulin resistance of the ovaries), and high testosterone drives more insulin, creating a vicious cycle and lots of inflammation.

Women with PCOS have an increased risk of infertility, obesity, metabolic disease, heart disease, and more. PCOS symptoms may change through perimenopause and other hormonal transition times of life.

PCOS and the Skin

Symptoms that show up on the skin can be signs of underlying hormonal and metabolic changes. With PCOS, the skin can provide early clinical clues that may lead to a proper diagnosis. PCOS skin symptoms may include acne, hair growth, and hyperpigmentation.

One study of 100 women with PCOS seeking treatment from a dermatologist:

• 78% had hirsutism (hair growth on the face and chest)
• 48% had acne (pimples, redness, inflammation)
• 31% had hair loss (on the head)
• 30% had acanthosis nigricans (hyperpigmentation, see more below)
• 29% had seborrhea (itchy, flaky skin on the scalp and face)
• 13% had striae (stretch marks)
• 9% had acrochordons (skin tags)

Let’s explore some of these PCOS-related symptoms and the hormones that drive them.

Acne

Acne vulgaris, especially on the jawline, chin, and upper neck, is a common occurrence in PCOS. In fact, when occurring in adult women, clinicians should consider it a possible clinical expression of PCOS. Acne lesions in PCOS can be large, deep, and slow to heal. They may get worse around menstruation.

Acne is strongly associated with insulin resistance, and elevated androgens also play a significant role. High androgen levels increase the size of the sebaceous glands (the glands that produce sebum) and increase sebum (oil) production, leading to oily skin. Further, androgens drive follicular hyperkeratinization, meaning the skin cells shed rapidly and abnormally, which contributes to clogged pores and acne.

Further, acne scars can become hyperpigmented, leaving dark spots even after acne has healed.

Hirsutism and Androgenic Alopecia

Along with acne, PCOS affects hair follicles in the skin and changes hair growth patterns and appearance. Androgen hormones, including testosterone, help regulate hair growth.

Hirsutism is one of the most common symptoms of PCOS and high androgens in women. Hirsutism refers to male hair patterns in women, with new hair growth on the face (chin, cheeks, and upper lip) and chest. It may affect 4 to 11% of women, but 65 to 75% of women with PCOS.

Although hirsutism is associated with high androgen levels, some women with PCOS will have normal androgen levels on lab work yet display hirsutism and other androgenic symptoms.

Androgenic alopecia refers to male-pattern hair loss, where the hair thins on the top of the head. Elevated androgen hormones, specifically DHT (dihydrotestosterone), which is more potent than testosterone, drive hair loss.

Hyperpigmentation

Acanthosis nigricans is a condition that involves the darkening of the skin in specific areas, such as the armpits, groin, and back of the neck. Symptoms are symmetrical, and the skin appears velvety. It is strongly associated with insulin resistance and seen in PCOS and other insulin-resistant conditions. Skin tags are another physical manifestation of insulin resistance and may appear along with hyperpigmentation.

Insulin is an important hormone for skin physiology; it helps maintain the balance of keratinocytes (skin cells) so they don’t proliferate or differentiate too much. This balance is essential to the skin’s structure. However, with insulin resistance and inflammation, this balance is lost, contributing to symptoms and driving even higher testosterone production.

Skin Healing for PCOS

Conventional medicine treats PCOS symptoms, and many women get prescriptions such as birth control, acne medications, and androgen blockers, all of which may help improve skin symptoms. However, this approach doesn’t address the root causes; once you stop the medication, the underlying hormonal imbalances and skin symptoms are still there.

Integrative medicine may utilize conventional medications as needed but also digs deeper to understand each woman’s specific hormonal landscape and the factors driving imbalances. We consider how lifestyle habits, stress, and environmental toxins contribute, and draw from a large pool of holistic and functional tools.

Some approaches for addressing underlying hormonal dysfunction and supporting skin health include:

• Balance blood sugar. Using nutrition, exercise, and supplements like inositol and berberine can help improve blood sugar balance, lowering insulin levels and improving insulin sensitivity. Balanced blood sugar and insulin help address other hormonal imbalances too, including testosterone.

• Support gut health. As hormone imbalances show up on the skin, so do gut imbalances and inflammation. The gut microbiome plays a significant role in hormonal and metabolic health, and strengthening it not only supports better functioning of these systems but also helps improve the skin.

• Decrease inflammation. PCOS is an inflammatory condition, and unchecked inflammation makes skin issues worse. Decreasing inflammation includes following an anti-inflammatory whole foods diet (with lots of skin and gut nutrients), optimizing omega-3 fats, and limiting inflammatory foods (like sugar and ultra-processed foods).

• Adopt a PCOS skincare routine. Use gentle, yet effective natural products that work for oily skin, acne, or your specific skin type. Cleansing and exfoliating help regulate oil production and remove dead skin cell buildup that clogs pores and promotes acne. Use active ingredients that strengthen the skin barrier and the skin microbiome. Wear sunscreen and choose non-comedogenic makeup. For specific guidance, we can refer you to a trusted dermatologist or aesthetician.

• Practice patience. Skin issues take time to heal, and your skin may not clear up as quickly as other symptoms when you put a plan in place. Practice patience and self-compassion as you work on each underlying factor. Trust that your body seeks balance and knows how to heal. Your job is to help create the healing conditions.

• Get support. There are a lot of pieces to the PCOS puzzle, and TārāMD can help you put them together and understand your complete picture. If you are frustrated with your skin and the treatments you’ve tried, integrative medicine can be a great next step on your healing path. You may need to consider pharmaceutical interventions which is nothing to be ashamed of if you have tried the aforementioned without as much relief as you need for your psycho-social health. Talk to us today and we can guide you towards the optimal integrative plan for your whole-body health.

With most women with PCOS experiencing some skin symptoms, we know it isn’t a skin issue, but a hormonal one. Don’t waste time suppressing symptoms when there is a path to long-term healing and clear skin. Healthier skin is just around the corner; give us a call today.

References

1. Purwar, A., & Nagpure, S. (2022). Insulin Resistance in Polycystic Ovarian Syndrome.Cureus, 14(10), e30351.
2. Lee, A. T., & Zane, L. T. (2007). Dermatologic manifestations of polycystic ovary syndrome.American journal of clinical dermatology, 8(4), 201–219.
3. Keen, M. A., Shah, I. H., & Sheikh, G. (2017). Cutaneous Manifestations of Polycystic Ovary Syndrome: A Cross-Sectional Clinical Study.Indian dermatology online journal, 8(2), 104–110.
4. Carmina, E., Dreno, B., Lucky, W. A., Agak, W. G., Dokras, A., Kim, J. J., Lobo, R. A., Ramezani Tehrani, F., & Dumesic, D. (2022). Female Adult Acne and Androgen Excess: A Report From the Multidisciplinary Androgen Excess and PCOS Committee.Journal of the Endocrine Society, 6(3), bvac003.
5. Napolitano, M., Megna, M., & Monfrecola, G. (2015). Insulin resistance and skin diseases.TheScientificWorldJournal, 2015, 479354.
6. Spritzer, P. M., Marchesan, L. B., Santos, B. R., & Fighera, T. M. (2022). Hirsutism, Normal Androgens and Diagnosis of PCOS.Diagnostics (Basel, Switzerland), 12(8), 1922.
7. Barbato, M. T., Criado, P. R., Silva, A. K., Averbeck, E., Guerine, M. B., & Sá, N. B. (2012). Association of acanthosis nigricans and skin tags with insulin resistance.Anais brasileiros de dermatologia, 87(1), 97–104.