Polycystic ovarian syndrome and acne Let’s know it

Polycystic ovarian syndrome and acne ..Today’s post is dedicated to girls, because I will talk about a picture that affects them exclusively: polycystic ovary syndrome (PCOS) . It is a disease that affects up to 8% of women of reproductive age, almost 1 in 10. It is the most frequent cause of infertility in women.

polycystic ovarian syndrome and acne

In the SOP can occur irregular menstruations, obesity, metabolic disorders and skin problems.
It is usually associated with obesity, irregular menstruation and other metabolic disorders. In addition, there are different skin problems : acne , androgenetic alopecia (loss of hair similar to that of men) or hirsutism (increased body hair). Surely many of you have heard speak directly or indirectly of him …

polycystic ovarian syndrome and acne


The SOP encompasses symptoms in the skin , but also at the hormonal and gynecological level . To be diagnosed with PCOS, 2 of the following 3 characteristics must be presented (as established in the Rotterdam criteria in 2003 by the European Society of Infertility and Embryology):

Oligo or anovulation: that is, not having menstruation, having it irregular, or despite having it not ovulating during it.

SOPClinical or biochemical signs of hyperandrogenism: this means presenting symptoms that are a consequence of an excess of androgens (male hormones) in the blood. What it implies is the appearance of acne, fat on the skin, more hair than normal or androgenetic alopecia . Before confirming the diagnosis of PCOS it is important to confirm that these symptoms are not due to other causes.

Polycystic ovaries diagnosed by ultrasound: a normal ovary when preparing for ovulation normally has a follicle from which the corresponding ovule will emerge that month. In girls with polycystic ovary, their ovaries have many follicles instead of one, but in many cases none of them eventually ovulates.


The symptoms that we can see in the skin of women with PCOS, are mainly due to the increase of androgens (male hormones). On the other hand, there are symptoms that are related to obesity or an increase in insulin resistance.

• acneAcne: the pimples that girls with PCOS usually have can be exactly the same as those of “normal” acne, typical of adolescence. In any case they have more tendency to be located in the lower part of the face, neck, neckline and upper back. In addition, it usually responds regularly to conventional treatments.

• Seborrhea: women with PCOS often complain that their skin is very oily and their hair often gets dirty.

• Hirsutism: it is an increase in hair in areas of men. It is common that girls with PCOS have more hair than usual in the upper lip, areaolas, chest, back and in the belly button area in the abdomen.

• Androgenetic alopecia : it is a loss of hair density, which is located in the upper part of the head, similar to the baldness of the boys, although the hair of the implantation line is usually preserved. It is the least frequent symptom of androgens of all, but perhaps the one with the greatest psychological repercussion. In any case, as it is rare that it is associated with SOP, it is important to rule out that there is no other cause that is triggering it.

Note that, interestingly, it is NOT necessary to have cysts in the ovaries to suffer from a polycystic ovary syndrome (PCOS) and, therefore, gynecological ultrasound can be rigorously normal .

The SOP is a much broader concept that is not only limited to the presence of ovarian cysts but to an endocrine disorder.

Likewise, it is possible to diagnose it by clinical history and physical examination (eg, if the first two criteria are met) without the need for a hormonal analysis and an ovarian ultrasound, although it is always recommended to practice them.

It should be noted that it is not strictly necessary to present disorders in the frequency of menstruation to have an SOP (in fact, 30% of patients with PCOS have regular menstruation).

Regarding the hormonal alterations in the analytical, in the syndrome of polycystic ovary the following characteristics are characteristic:

· Decrease in sex hormone-binding globulin (SHBG).
· Increase in free testosterone and free androgen index.
· Increase in dihidepiandrosterone sulfate (DHEAS).

Why does polycystic ovary syndrome appear?
The reason why it appears is not known, although it is known that there is an excess of luteinizing hormone ( LH )secretionby the cerebral pituitary gland, which will stimulate the ovary to the production of androgens (androstenedione). In turn, these will cause the follicles to remain immaturein the ovary(formation of cysts) and perform their hormonal effect on peripheral tissues ( hyperandrogenism ).

acne sop polycystic ovarian syndrome

Scheme 1: hormonal disorder related to androgens present in the SOP

acne sop polycystic ovarian syndrome

Scheme 2: disorder related to insulin present in the SOP

What are the most frequent manifestations of PCOS?

Up to 60% of patients with polycystic ovary syndrome have high total testosterone in their blood and 70% have hirsutism of variable degree, which are associated with a higher risk of metabolic and reproductive morbidity.

ultrasound polycystic ovarian syndrome

Acne and facial hirsutism.

ultrasound polycystic ovarian syndrome

Observe the comedones and hirsutism.

ultrasound polycystic ovarian syndrome

Abdominal hirsutism.

What are the peculiarities of acne in girls with polycystic ovarian syndrome?

Predominantly, it has inflammatory lesionsin the lower third of the face , neck, chest and upper back.

Between 19-37% of women with moderate or severe acne meet diagnostic criteria for PCOS , so it is highly recommended to study in detail all women with acne by practicing a clinical history, a complete physical examination, a hormonal analysis and a gynecological ultrasound.

This is especially true in those women in whom acne has debuted or persists in adulthood , or in those who are resistant to the usual therapies or relapse after the end of isotretinoin treatment .

It is estimated that up to 30% of women with polycystic ovarian syndrome have acne.

acne young women

Photo of woman with acne: women with acne in adulthood and / or who are resistant (even to isotretinoin) should undergo a detailed study to rule out the presence of an SOP as the underlying cause.

What is the treatment of polycystic ovarian syndrome?

Not all patients with PCOS require pharmacological treatment. The simple loss of weight in patients who associate obesity is able to improve all non-cutaneous manifestations of this disorder (fertility and metabolic syndrome).

· Oral contraceptives with progestins derived from 19-nortestosterone. These include oral contraceptives (OCPs) that include ethinyl estradiol plus a specific progestogen (norgestrel, levonorgestrel, norethindrone, norgestimate, desogestrel, or gestodene). They are effective for menstrual irregularity , reduce the risk of endometrial hyperplasia , hirsutism and -according to several but not all studies- acne .

This type of OAC has an indirect antiandrogenic profile for three reasons: they increase the synthesis of SHBG (reduce circulating free testosterone); reduce the synthesis of ovarian androgens by reducing LH thanks to the progestogens they contain; and the androgenic receptors and 5 alpha reductase also decrease thanks to the progestogens.

However, they increase the risk of some thromboembolic cardiovascular events (cerebral vascular accidents, venous thrombosis, mycocardial infarction), breast cancer , insulin resistance and dyslipidemia .