PCOS hormonal acne - any skincare advice

[minipie]

I’ve had acne since my teens. Diagnosed with PCOS in my 30s. I’m now pushing 40 and still have acne. I’ve tried all the medications (Dianette, topical antibiotics, benzoyl peroxide, Roaccutane, Spironolactone, also a period of dairy free) Some have had some effect but then plateaued, none cleared it up totally.

Due to the acne and being overwhelmed I’ve shied away from most skincare. I currently use almost nothing. But I’d like to try a different approach. I’m worried though about anything that will make the acne worse. Serums and heavy moisturisers seem likely to clog my skin - I think?

I do need a decent cleanser though (currently using wipes ) and perhaps retinol? My skin seems pretty tough and doesn’t react.

Any recommendations, specifically for people with acne? Most people seem to have dry sensitive skin - that’s not me!

I've been battling PCOS bad skin for years. Would suggest a simple cleanser - Cerave hydrating cleanser is good and not too expensive - and tretinoin. This is the only thing that has worked for me in the sense it thins your skin and stops the pores getting clogged in the first place. It's not for everyone and if you haven't already you could give azelaic acid a try first.

Tretinoin is available from a dermatologist on prescription, from Dermatica as part of a monthly regime or over the counter in some European countries including Spain

I have PCOS and am spotty. My skin is dehydrated and I find that products actually make it worse.

Over the years, I've tried the Body Shop, Liz Earle, la Roche Posay, Superdrug naturally radiant.

I currently use;
Body shop camomile cleaning oil
Lush tea tree toner (antibacterial)
The ordinary azaleas acid

.......
Niacinamide
Hyalauronic Acid
Buffet

I emailed them and they sent me a routine. I still need to tweak it.

If roaccutane hasn’t worked nothing otc or from the gp will have an effect. You need to go back to the gp & request another referral to dermatology for another course.

It only works first time for 8 out of 10 patients. One of the dermatology nurses I saw when I was on roaccutane had taken three courses but had beautiful skin.

I have pcos and as I’ve aged, 43 this year, the oestrogen is declining & the androgens are taking over. My acne went cystic at 41 which is incredibly painful.

Thank you all! So sorry you all have the same issues, but selfishly it’s nice to find fellow sufferers!

I’ve had Roaccutane twice, once as a teen and once mid 30s. Both times it worked 75% and then plateaued. Spironolactone (still taking that) the same. Maybe I should try again on the Roaccutane, I was on it a long time though. I had it privately (v expensive) so am not sure if NHS would prescribe it.

I will look into all the things mentioned as have never tried any of them.

Empress who did you email?

I can get stuff from France fairly easily, anyone know if tretinoin is available otc there or any brands to look for?

Also what about anti ageing - Sadly I am now having to think about wrinkles as well as spots

Fluffy that’s very depressing! I was hoping peri menopause etc might help!

Acne was my main PCOS symptom (other than subfertility and very irregular periods). It was alleviated by the right oral contraceptive (but exacerbated by the wrong ones) - I was on Microgynon before I had DD and Marvelon after (with a brief try of Dianette which made me depressed). One size definitely doesn't fit all with pcos but might be worth trying.
I didn't get much acne during and now after menopause though I do get rosacea - it seems to have settled down at the moment.

Epiduo cream worked a treat for me, have you tried that?

How is your diet now? After being prescribed Dianette and various creams over the years (all useless), my hormonal acne cleared up when I quit dairy entirely and cut wheat down to once a week. Soya milk also affects your hormones so that should be avoided.

Can you do an elimination diet for a week and then reintroduce different types of food gradually? Are you on any hormonal birth control? This has a huge effect. I quit the pill entirely and my skin has never looked better, this depends on your relationship status though!

Re: skincare, gentle is best so a cleansing oil, a hydrating watery toner, a serum (Superdrug Simply Pure is light and non irritating) and a basic moisturiser (The Ordinary NMF) mixed with a few drops of oil (Rosehip is good for healing) will help your skin to balance and heal.

Hormonal acne needs to be tackled from both the inside and the outside, there's no easy fix. Good luck!

Three things that have worked for me at different times in my life :

Dianette contraceptive pill - life changing until my migraines prevented me from using it 😭

Light therapy - at home, look at this kind of thing: www.lumie.com/products/clear Cheaper versions are out there.

The Ordinary products - that's what Empress is referring to. I use their AHA/BHA skin peel once a week or so, plus daily Niacinamide when I have an outbreak, or Hyaluronic Acid when it's clearer. I also have some retinol, but I think I picked one that's too strong for my skin.

Highly recommend The Ordinary.

@minipie if anything it gets worse because there’s less oestrogen to counterbalance the androgens.

So, leave hormones out of it and focus on the fact you have an excess of oil on your skin that the bacteria can munch on. If the oil isn’t there the bacteria effectively starve & die.

Roaccutanes for cystic acne and mild persistent acne that doesn’t respond to the normal prescription treatments. My dermatologist prescribed me 4 months & at my last appointment told me to request a referral to them for another course if he acne came back.

I had one spot in the first four weeks after stopping treatment and since then nothing. I wash with Aldi foaming facial wash twice a day & have no spots. I came off 1st July.

Have you ever tried Yasmin? My skin was absolutely awful for years and I tried everything - including lots of old wives' tales!

Then I decided to try Yasmin to regulate my periods, which it did, but as a beautiful side effect my skin completely cleared up, too. After suffering from acne since the age of 11 - I was 27 when I went on Yasmin - it was enough to make me cry when I saw what it was doing.

I’ll just add I’ve got a cows milk allergy for 15 years, cutting it out made no difference.

I have tried Microgynon, Yasmin, Dianette. Don’t remember Marvelon but dermatologist said stay away from all hormonal contraception except Yasmin/Dianette? Came off Dianette about 6 months ago - dr said they won’t prescribe it past 40 due to side effect risks.

Yes I have tried Epiduo, was probably the best of the topical options.

All of these had some effect but no full cure even when combined with medications. I was on Roaccutane for over a year... dermatologist was mystified as to why it wasn’t working.

I tried laser therapy in my 20s - didn’t do much - not tried the light boxes though.

I haven’t tried exclusion diets properly. I have been wheat free in pregnancy due to GD (low carb diet) and dairy free when DD was newborn due to her suspected reflux. Neither changed my skin much... but my hormones were weird at those times so not a proper test. I love dairy so would possibly rather have acne than give it up...!

Your comments have encouraged me to keep trying things though. I will look at the light thingy and The Ordinary and other cleanser/acid suggestions.

Did they have you on a very low dose?. They used to think a low dose over a longer period worked but I think that’s been debunked now.

I’m petite so they put me on 40mg a day for 16 weeks.

You definitely should avoid progesterone based contraception.

I can’t remember dose but 40 sounds familiar, it wasn’t a low dose which is why she was so puzzled. It might have been 30 then up to 40 when 30 didn’t work. I’m petite too.

I’m 51kg so they started me on 30, then 40 after a month.

Did you get the dry lips? I know someone who took it but didn’t get the dry lips BUT I’ve noticed she eats very low fat & I wonder if she was absorbing it.

I eat a lot of fat anyway but they stressed at each appointment I needed to eat fat so I think they had me down as a dieter plus with pcos they expect you to be overweight.

Yes I think I was the same dosage as you, probably a few kg heavier maybe 55.

I got very dry lips when on Roaccutane as a teen but not so much in my 30s. I had high blood lipids though so maybe that’s why. So I didn’t get nagged to eat fat quite the opposite!

Just don’t know why it didn’t work - very annoying!

I could have written your post - spiro, roaccutane (3 courses) diet changes and then last year I tried DIM supplement - it took 3 weeks to kick in and then all cystic acne GONE and has stayed away. Google oestrogen dominance and then google DIM supplement from Amazon. . Read the reviews bwht please please try it - it has changed my life and my personality.

That’s very interesting- I actually have a bottle of DIM unopened in a drawer - I bought it then realised I have no idea if I am oestrogen dominant! How do I know?!

If you have PCOS you are oestrogen dominant - there are online quizes you can take or check out Eric Berg on Youtube - he has a great video on Oestrogen Dominance

See this is my problem I don’t do the research 😁 I will give it a go thanks

Sorry last question, you said the DIM took 3 weeks to kick in, did your acne get worse in those 3 weeks or just not change?

Much as I hate to admit it, there is a clear link between the state of my skin and how much sugar & gluten I eat.
I also have to be really careful what shampoos I use as some can cause me to get lots of spots along my hair line and they're not as well hidden by my fringe as I like to think they are

cobwebs mine’s definitely not shampoo related, I almost never get hairline spots. Mine are jawline and lower cheeks, a
few around nose/forehead. Not cystic. They arrive the week before my period and take the rest of the month to go so by the time they are clearing the next lot turn up. I’m best suited weight wise to a low GI diet but it doesn’t seem to change my skin.

I will look into the DIM - having googled oestrogen dominance a lot fits, not all but quite a bit. If the DIM makes me less grumpy that will be a major bonus