The Overlooked Skin Symptoms of PCOS: What to Watch For and How to Treat Them

As a beauty editor, I’m supposed to have all the answers. But when it came to my own skin and body, I was clueless.

Persistent blemishes along my jawline, itchy eczema flare-ups, irregular periods, and unexplained weight gain were a constant source of frustration, driving my search for solutions.

Then, what I thought would be a routine hormone check-up at the endocrinologist turned into something more serious. An ultrasound revealed tiny cysts on my ovaries, while blood tests showed elevated glucose levels that bordered on pre-diabetes.

The diagnosis: Polycystic ovary syndrome (PCOS), a condition I had never even linked to my skin issues. I had so many questions, and I’m sure now, you do too.

To cut through the noise, I turned to a team of top specialists who see firsthand how PCOS affects the skin and how a holistic approach can offer both relief and results.

Meet the Experts

• Dr Daphne Lee: Dr Lee is an accredited endocrinologist practising at Dr Daphne Lee Endocrine And Diabetes Medical Clinic. She treats a wide range of endocrine conditions, including diabetes, thyroid disorders, and obesity, with a special interest in adrenal and pituitary health.
• Dr Stephanie Ho: A British-trained Consultant Dermatologist registered in both Singapore and the United Kingdom, Dr Ho has over 25 years of experience and practice at Stephanie Ho Dermatology. Her specialities include skin cancer screening, laser treatments, and pediatric and adolescent skin care.
• Dr Tan Siew Kang: Practicing at The Dermatology Practice, Dr Tan is a Ministry of Health-accredited dermatologist with over a decade of experience. Her practice focuses on general, aesthetic, and laser dermatology.
• Diane Seto: Diane is a senior dietitian at Mount Elizabeth Hospital in Singapore, with over six years of clinical experience. She specialises in working with patients managing diabetes, cardiovascular disease, weight management, and irritable bowel syndrome.

What Is PCOS, and Why Does It Affect the Skin?

PCOS is a hormonal disorder that affects women of reproductive age, around 10% of women in Singapore. While irregular periods and difficulty getting pregnant are common symptoms, many women also experience skin issues.

According to Dr Daphne Lee, “Skin issues are one of the common symptoms of PCOS, and patients do present with skin concerns as they tend to be readily visible.”

The statistics are telling. Dr Tan Siew Kang reports that “about 70% to 80% of women with PCOS have cutaneous signs.”

“50 to 80% of PCOS patients present with acne, hirsutism and seborrhea, whilst 10 to 30% present with androgenetic alopecia, acanthosis nigricans and skin tags,” Dr Stephanie Ho adds.

Common Skin Conditions Associated with PCOS

Several skin conditions are particularly prevalent among those with PCOS:

• Acne: Dr Lee emphasises that acne in PCOS tends to be deeper and more severe, particularly affecting the lower face, including the chin and jawline. Dr Tan further states that “40 to 50% of women with PCOS experience acne vulgaris.”
• Hirsutism: This condition manifests as excessive hair growth in male-pattern areas, such as the upper lip, chin, and abdomen. Dr Ho explains, “Hirsutism is caused by the raised androgens seen in PCOS,” affecting 70 to 80% of patients.
• Acanthosis Nigricans: Characterised by dark, velvety patches of skin, typically found on the nape of the neck and in skin folds, acanthosis nigricans affects 10 to 30% of those with PCOS. Dr Tan notes, “It commonly affects PCOS patients who are overweight or insulin resistant.”

The visibility of these skin symptoms can incite significant emotional distress.

Dr Lee highlights that “skin symptoms can lead to low self-esteem and poor body image,” while Dr Ho adds that many women with PCOS experience “depression and sexual dysfunction” due to their skin manifestations.

PCOS Skin Symptoms: Acne

Acne in women with PCOS is primarily driven by hormonal imbalances. Dr Ho outlines several key factors:

• Elevated androgens: Increased levels of male hormones, such as testosterone, heighten oil production, clogging pores and leading to inflammation.
• Insulin resistance: This happens when the body’s cells don’t respond well to insulin, a hormone that helps regulate blood sugar. As a result, the body needs to produce more insulin to keep blood sugar levels stable. This exacerbates acne by increasing free androgens, further influencing oil production.
• Hormonal fluctuations: A relative deficiency of estrogen and fluctuating progesterone levels contribute to the severity of acne.

Dr Tan notes that “androgens also slow down the skin’s turnover rate,” causing a buildup of sebum and dead skin cells, which can trap bacteria and lead to further acne development.

Treatment Strategies for Acne in PCOS

Fortunately, there are various treatment strategies available for managing acne in women with PCOS. Dr Ho says that “hormonal treatments such as oral contraceptive pills” can help regulate androgen levels.

Additional options include:

• Anti-androgens like spironolactone.
• Insulin-sensitising agents such as metformin.
• Topical treatments like benzoyl peroxide and retinoids for mild cases.
• Oral antibiotics for reducing inflammation.

Dr Tan advocates for combined oral contraceptives as a preferred first-line therapy, particularly when topical treatments fail to yield results.

Common Nutritional Deficiencies in PCOS Patients and Their Link to Acne

It’s essential to consider how nutritional deficiencies may play a role in skin health, particularly in relation to acne. Insights suggest that certain micronutrient deficiencies could exacerbate skin issues commonly seen in PCOS patients.

Diane notes that acne has been linked to deficiencies in the following micronutrients:

• Vitamin E: Acts as an antioxidant and anti-inflammatory. Good sources include eggs, green vegetables, tomatoes, and walnuts.
• B vitamins: Particularly B1, B2, B3, B5, B6, and B7, help reduce sebum secretion and bacterial colonisation. Found in eggs, lean meats, fish, beans, dairy products, and whole grains. Be cautious with vitamin B12 supplements, as high doses may worsen acne.
• Vitamin D: Regulates sebum production, inhibits acne-causing bacteria, and reduces inflammation. Deficiency is common in acne patients, and supplementation (1,000 IU/day) has shown beneficial effects. Sources include fatty fish, eggs, and liver.
• Zinc: Has anti-inflammatory and antibacterial properties. Low zinc levels are associated with acne. Foods rich in zinc include oysters, pumpkin seeds, and whole grains.

PCOS Skin Symptoms: Hirsutism

Hirsutism is a condition in which women experience excessive hair growth in areas where men typically grow hair, such as the face, chest, back, and abdomen. This hair is usually dark and coarse, resembling male-pattern hair growth.

Dr Ho notes that “hirsutism is an important diagnostic sign of PCOS.” Treatment typically involves similar hormonal therapies, alongside options like waxing, shaving, and laser hair removal.

Dr Tan adds that “Vaniqa (Eflornithine) is the only topical skin cream treatment available for hirsutism,” although it is not available in Singapore.

Dietary changes can also influence androgen levels, particularly for managing hirsutism symptoms. Diane Seto points out that hirsutism in PCOS is linked to hormonal imbalances, especially insulin resistance and elevated androgen levels.

A high-fibre, calorie-restricted diet can improve blood sugar control, lower insulin levels, and potentially benefit hirsutism management in overweight or obese women.

Does Spearmint Tea Help With Hormonal Acne and Hirsutism?

Spearmint tea has become a popular choice on TikTok for those seeking natural remedies for hormonal acne, particularly in cases related to PCOS. Research indicates that spearmint tea may play a role in reducing androgen levels, a common contributing factor in both hormonal acne and hirsutism.

Diane references a 30-day randomised controlled trial involving 42 women with PCOS, which found “significant reductions in free and total testosterone among participants who drank spearmint tea, compared to those who drank placebo.”

She explains that while improvements in hirsutism symptoms were reported among spearmint tea drinkers, “objective measures did not show significant changes.”

Dr Lee adds, “There are some small-scale scientific studies that suggest a positive effect of spearmint tea on hirsutism but the data is insufficient to reach a definitive conclusion at this point.”

Spearmint tea shows promise as a complementary approach, but it is not yet established as a standalone treatment.

PCOS Skin Symptoms: Acanthosis Nigricans

Acanthosis nigricans is a skin condition marked by dark, thickened, and velvety patches that typically appear in body folds like the neck, armpits, groin, and under the breasts. Surprisingly, it is primarily associated with insulin resistance.

Dr Ho explains that it occurs when “excess insulin stimulates the overgrowth of skin cells,” which is why the affected areas may also feel slightly raised and have a rougher texture compared to the surrounding skin.

Treatment strategies include:

• Insulin-sensitising agents like metformin.
• Hormonal treatments.
• Lifestyle changes focused on diet and exercise.

Dr Tan stresses the importance of addressing underlying insulin resistance through weight loss and exercise, which can improve skin symptoms.

Diane suggests, “A diet low in added sugars and refined starches while increasing fibre intake” may help manage acanthosis nigricans. A balanced diet with low glycemic-index foods is beneficial for overall skin health.

Is There a Link Between PCOS and Eczema?

While eczema is not a direct symptom of PCOS, hormonal and inflammatory disruptions associated with the condition may heighten its severity.

As Diane explains, “Eczema (atopic dermatitis) is a chronic skin condition characterized by dry, itchy, and inflamed patches of skin.” She highlights that dietary management strategies for PCOS can also alleviate eczema symptoms.

A recent study noted that “significant skin improvements were found after eliminating refined flour products and junk food, as well as increasing the intake of vegetables and fish oil, which is rich in anti-inflammatory omega-3 fatty acids.”

Lifestyle Modifications to Alleviate PCOS Skin Symptoms

Lifestyle choices such as diet, exercise, and stress management are pivotal in managing PCOS symptoms, particularly those related to skin health.

“Chronic stress can increase levels of cortisol, a stress hormone that raises androgen levels,” notes Dr Ho. “Managing stress with regular exercise, meditation, breathing exercises, and adequate sleep is important for hormone regulation.”

Dr Ho says, “Lifestyle modification is an important treatment strategy for patients with PCOS. A balanced, low glycemic diet can help regulate blood sugar levels and reduce insulin resistance, a major driver of androgen excess in PCOS.”

Dr Tan adds, “Adopting a balanced diet rich in fibre, low in processed foods and refined sugars, can help regulate insulin levels and reduce insulin resistance,” which is crucial for preventing skin manifestations.

“Research suggests that a high-glycemic index diet, which includes a lot of refined carbohydrates, can cause blood sugar spikes,” Diane explains. “This triggers the body to release more insulin, which increases the levels of hormones like insulin-like growth factor 1 (IGF-1) and androgens.” Such hormonal imbalances contribute to acne development.

Moreover, maintaining hydration is essential. Diane emphasises, “Hydration helps regulate oil production, supports the skin’s natural detoxification process, and reduces inflammation.”

Managing a healthy diet amidst the challenges of PCOS can be daunting. Diane recommends practical strategies like meal prepping, planning meals ahead, and mindful eating to help patients navigate cravings and food intolerances.

She highlights the importance of “support systems, such as engaging with support groups or a dietitian, for guidance and motivation.”

Supplements to Manage PCOS Skin Symptoms

While some supplements may help manage PCOS-related skin symptoms, expert opinions vary on their effectiveness. Dr Lee suggests that “inositol has been suggested as a supplement to help with PCOS,” but cautions that “evidence to support its use is limited and inconclusive for now.”

Diane says it’s best to confirm any micronutrient deficiencies before starting supplements.

“For acne and hirsutism, supplements such as vitamin D, selenium, zinc, inositol, spearmint, alpha-lipoic acid, and chromium picolinate may be beneficial,” as they can help reduce insulin resistance and lower androgen levels.

Advances in Research and Treatment

Recent research on PCOS has brought renewed hope for more precise and effective treatments.

Dr Ho mentions that “GLP-1 agonists can promote weight loss, leading to improved insulin sensitivity and reduction in hyperandrogenism symptoms.” Dr Lee adds that genetic and genomic studies are emerging, providing insight into how individual genetic profiles affect symptom severity and treatment responses.

As Dr Tan notes, “Recent studies have suggested that artemisinin, a herbal extract, blocks an enzyme crucial for testosterone production.” While promising, larger trials are needed to evaluate its long-term safety.

Navigating the skin challenges that come with PCOS can be frustrating, but the right blend of targeted skincare, diet adjustments, and medical support can make all the difference.

Taking charge of your skincare routine and lifestyle can be empowering, and with the guidance of specialists, you’ll be better equipped to manage those fluctuations.

Remember, every skin journey with PCOS is unique – and the more you understand and address yours, the better you’ll look and feel.