Seeking Guidance: Acne Linked to PCOS
[19, Female] Height: 5'5", Weight: 60kg; I occasionally drink alcohol and smoke, but these are not frequent habits. To provide some background, I experienced my first significant breakouts around age 17. Until that point, I had been using Benzoyl Peroxide (Benzac) between the ages of 14 and 17 for typical teenage acne, which had worked well for me. However, by 17, that treatment ceased to be effective, and I developed a severe breakout primarily on my lower face. Over the course of the next 18 months, it spread to my cheeks, upper cheeks, and the area between my eyebrows. Now at 19, my skincare journey has involved adopting a highly nutritious diet, as I have a keen interest in nutrition and natural healing. I avoid refined sugars and gluten (due to intolerance) and ensure I'm getting ample protein, fiber, and micronutrients. My diet is rich in a diverse range of vegetables and is anti-inflammatory. I engage in weight lifting five days each week, maintain a BMI of 21, practice yoga regularly, and seek sunlight daily. I undertook two parasite cleanse protocols with ingredients like black walnut, wormwood, clove, oil of oregano, and a binder, which provided minimal improvement—although some benefits may have been due to other topical treatments I used. In the mornings, I take inositol and berberine as part of a balanced breakfast designed to stabilize my blood sugar. Later in the day, I incorporate omega-3s, turmeric, and probiotics into my regimen. After conducting more research, I've begun introducing zinc bisglycinate, magnesium glycinate, and NAC to help mitigate inflammation and stimulate progesterone production. My recent blood tests indicated that my progesterone levels were extremely low, suggesting that I did not ovulate—this was assessed during my day 22 luteal phase. Additionally, I have bi-weekly acupuncture sessions, maintain good sleep hygiene, and wash my bed linens regularly. In August 2025, I was prescribed Tretinoin at 0.025% alongside clindamycin at 1%. This regimen yielded a significant reduction in the acne on my cheeks and the bulk of my chin. Nevertheless, I still contend with persistent acne around my mouth, extending down to my chin, which appears to be hormonally driven. This acne is notably inflammatory, manifesting as red, pustular blemishes. After enduring roughly a year of persistent acne, I was diagnosed with polycystic ovary syndrome (PCOS) in early 2025. I've undergone two internal ultrasounds, both revealing multiple follicles on my ovaries, and experienced a phase of irregular menstrual cycles—from January to September 2025—wherein I occasionally skipped cycles. This irregularity has coincided with a worsening of my acne, which is at its worst level yet. Importantly, I have never used hormonal birth control. Thankfully, my cycles are now stabilizing due to regular acupuncture, and appear to be normalizing. My hormone tests show normal results (with testosterone in the lower range), but I haven't had my DHEA-S levels tested, which many women with PCOS find to be significantly elevated. Both my fasting insulin and glucose levels are low-normal, and I've calculated my HOMA, which is also low. However, I have yet to undergo an Oral Glucose Test for a more precise assessment. My treatment with Tretinoin was increased to 0.05% about a month ago, while I continue with clindamycin at 1%. Four months ago, I added both azelaic acid and niacinamide to my regimen, and most recently, at my doctor's recommendation, I began using a mild natural salicylic acid treatment (from MooGoo) about four weeks ago to enhance the effectiveness of Tretinoin. To protect my skin barrier, I utilize a non-comedogenic moisturizer (Amperna) with postbiotics and ceramides, along with a zinc oxide SPF daily. I also get acne-targeted skin peels every three weeks and plan to complete six rounds. Despite all these measures, my skin remains stubbornly symptomatic; the issues appear localized to the lower face below my mouth, suggesting a hormonal imbalance. The pursuit of clear skin feels increasingly elusive. I also experimented with Traditional Chinese Medicine (TCM), which included personalized herbal blends taken thrice daily, adherence to a low-carb diet, avoidance of raw vegetables and cold foods, as well as consistent acupuncture. Unfortunately, this approach did not yield the desired outcomes. I attempted to reintroduce Benzoyl Peroxide but only observed limited effects. Aloe vera treatments have proven ineffective as well. I genuinely feel like I've tried nearly everything available. I'm currently eliminating dairy from my diet for six weeks to see if it aids my skin, having never cut it out before. Although my insulin seems to be functioning optimally, I'm willing to try different approaches. Additionally, I've started consuming spearmint and licorice root tea twice a day and have recently acquired chaste berry tea to support hormonal balance. However, I'm uncertain about the timing for its use during my cycle. I would greatly appreciate any insights, assistance, or recommendations. I have avoided medications and hormonal birth control until now, and I'm eager to keep it that way, yet I remain hopeful for effective solutions. Although my current acne is manageable, I long for the clarity of healthy skin, and I find myself puzzled about why, despite my lifestyle choices, I haven't achieved this goal.
Answers (1)
3/4/2026, 11:30:56 AM
OpenHealth AI
It sounds like you've been on quite a journey with your skin and overall health, and it's commendable how proactive you’ve been in trying various approaches to manage your acne and support your hormonal balance. Addressing acne related to PCOS can be complex, but I'm here to help guide you through some considerations and suggestions based on your detailed situation.
Main Points:
- Persistent acne, especially in the lower face, suggests a hormonal component strongly linked to your PCOS.
- Your current skincare regimen is extensive; however, we may need to refine or add to it for better results.
- Dietary adjustments and herbal remedies may also play a role in supporting hormonal regulation.
Explanation:
Acne associated with PCOS is often inflammatory and can be indicative of underlying hormonal imbalances, particularly involving androgens. Your use of treatments like Tretinoin, clindamycin, and continued exploration of natural remedies indicates a solid foundation. However, persistent symptoms suggest that additional strategies may be warranted.
Next Steps:
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Hormonal Testing: Since you mentioned low progesterone and irregular cycles, consider testing for DHEA-S levels as elevated levels can be linked to acne in PCOS. An Oral Glucose Tolerance Test could also provide more insight into insulin sensitivity.
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Dietary Adjustments:
- You might find additional benefits from a low-glycemic diet that further reduces sugar spikes. Keeping a food diary could help identify any triggers.
- Continue with the elimination of dairy but carefully observe any changes in your symptoms during this period.
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Herbal Remedies: You mentioned starting spearmint and licorice root teas. These have been shown to help lower androgen levels:
- You can use spearmint tea in the two weeks before your expected period, as it may help regulate hormones.
- Licorice root can also be beneficial if used in moderation; however, avoid long-term use without a break due to potential side effects.
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Lifestyle Adjustments:
- Continue stress-reducing practices like yoga and acupuncture.
- Ensure adequate hydration and perhaps explore supplementation with omega-3s which may help reduce inflammation.
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Skincare Refinements:
- Consider varying your exfoliation methods; for very stubborn acne, adding a salicylic acid treatment might be beneficial, but be sure to monitor the skin’s response.
- Maintaining the integrity of the skin barrier with your current moisturizer is vital, especially since you are on active treatments.
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Support Groups or Community: Engaging with others who are dealing with similar issues can offer not only emotional support but also practical advice based on shared experiences.
Reassurance:
Your body is going through a lot of changes, and it’s important to be patient with the process. Improvement may take time, especially with hormonal issues. Continue to track your symptoms and responses to treatments carefully, and don't hesitate to adjust as needed. Your commitment to your health is impressive, and with ongoing adjustments, clearer skin is attainable in the future. If you have further questions or need clarification on any of the suggestions, feel free to ask!
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