How to Overcome Hormonal Acne Caused by PCOS

Polycystic Ovary Syndrome (PCOS) affects up to 1 in 10 women and is one of the most common causes of persistent hormonal acne. These breakouts typically appear around the lower face, jawline, chin, neck, and can also affect the chest and back. They often flare cyclically or remain chronic due to androgen excess, insulin resistance, systemic inflammation, and gut-skin dysregulation.

Typically it is managed using a combination of medical therapies and topical interventions. Common medications include the Oral Contraceptive Pill, Spironolactone, Roaccutane, Metformin, and topical or oral antibiotics. Dermatological topicals may feature prescription retinoids, salicylic acid, or benzoyl peroxide.

These medical strategies can be highly effective. However, many individuals prefer to explore alternatives before initiating medication, or they aim to integrate a comprehensive, holistic approach that combines medical care, skincare optimisation, and targeted lifestyle adjustments. At The Skin Insider, we support clients in addressing the internal drivers of PCOS-related acne, with or without medication, because sustainable improvement requires working at the root cause.

This blog outlines essential lifestyle and nutritional strategies for those of you who want to ensure every contributing factor is considered in your acne healing journey.

Step One: Nutrition Considerations

1. Stabilise Blood Sugars to Reduce Androgen Excess:

Insulin resistance is highly prevalent in PCOS, impacting an estimated 70-90% of women diagnosed with the condition. It plays a central role in driving many hallmark symptoms of PCOS by elevating androgen levels, particularly testosterone, and amplifying systemic inflammation. 

This hormonal and inflammatory cascade contributes to increased sebum production and painful cystic breakouts, alongside common concerns such as irregular menstrual cycles, weight management difficulties, and excess facial or body hair.

Practical guidelines:

• Prioritise high-quality lean proteins from both plant and animal sources (aiming for 15-30g per meal)

• Choose low GI carbohydrates like beans, lentils, chickpeas, sourdough bread, rolled oats, wholegrains and vegetables

• Reduce high GI and ultra-processed foods like pastries, cakes, white bread, deep fried foods, sugary drinks and lollies 

• Pair carbohydrates with lean proteins (chicken, lean red meat, fish, seafood, legumes, tofu, eggs, dairy, nuts and seeds), fibre (vegetables, fruit, legumes, nuts and seeds) and healthy fats (avocado, extra virgin olive oil, oily fish, nuts and seeds)

• Prioritise carbohydrates earlier in the day when our body is naturally more insulin-sensitive and include more fibre and lean proteins for the evening meal

Examples:

• For breakfast: eggs + avocado + sourdough toast + sauteed spinach

• For lunch: chicken skewers + basmati rice & lentils + roasted cauliflower

• For dinner: salmon fillet + steamed broccoli + carrot + green beans + corn cob

2. Support Gut and Liver Function:

Dysbiosis and poor detoxification can increase circulating androgens and inflammatory markers, so promoting the health of our gut microbiome and liver is crucial for PCOS and hormonal acne management. 

Include daily:

• Prebiotic fibre for the ‘good’ gut microbes (e.g. sweet potato, cauliflower, garlic, onions, asparagus, watermelon, mushrooms, etc.)

• Fermented foods (e.g. kefir, sauerkraut, Greek yoghurt, kimchi, tempeh, etc.)

• Cruciferous vegetables (e.g. broccoli, kale, cauliflower, brussels sprouts, cabbage) for estrogen detoxification

• Hydration (2-3L water per day)

3. Incorporate Antioxidant and Anti-Inflammatory Foods:

Inflammation is a key driver of acne flares, so prioritising antioxidant and anti-inflammatory foods is an essential nutritional strategy for supporting clearer, calmer skin for those with PCOS. Additionally, reducing pro-inflammatory foods is equally as important.

Key inclusions:

• Berries

• Green tea

• Garlic and Onion

• Extra virgin olive oil

• Oily fish

• Tomatoes

• Raw cacao powder

• Avocado

• Apples

• Ginger

• Herbs and Spices

Key exclusions (or reduce):

• Refined carbohydrates and sugary foods

• Excess red meat and processed meats

• Deep fried foods

• Trans fats

• Alcohol

• Diet and regular soft drinks

4. Reduce Dairy Only if Symptomatic:

Some women with PCOS are more sensitive to dairy due to IGF-1 stimulation, however dairy is not something everyone with PCOS needs to reduce. If you feel it is exacerbating your acne symptoms, trial a reduction for 4-6 weeks and monitor your skin response. Gradually reintroduce it (ideally under expert guidance) and assess your tolerance level. 

Also, contrary to what a lot of people believe, the research shows that full-fat dairy is linked to reduced IGF-1 levels, reduced androgen secretion and improved ovulation performance, so we do not recommend low-fat dairy products for this reason.

Step Two: Lifestyle Interventions

1. Introduce Post-Meal Movement:

If you aren’t already, we highly recommend incorporating a short 10-15 minute walk immediately after eating as this has been shown to significantly lower blood sugar levels and improve insulin sensitivity.

This is a simple way to improve your hormonal balance, blood sugar management, digestion and mental clarity.

2. Periodised Exercise for Insulin Sensitivity:

Both strength (resistance) training and aerobic (cardio) exercise improve insulin sensitivity and reduce androgen levels and blood sugar levels.

To start: Aim for 2-3 strength sessions + 150 minutes of moderate cardio per week.

3. Stress Regulation to Support Hormone Balance:

Chronic cortisol elevation as a result of chronic stress worsens insulin resistance, increases inflammation, and disrupts sex hormone balance. This combination creates the ideal environment for cystic acne flare-ups.

Structured stress-modulating practices can improve hormonal homeostasis and skin health.

Structured practices:

• Recognise that rest and relaxation are just as important as work. Implement activities that you enjoy and take time away from the hustle and bustle.

• Incorporate guided breathwork or meditation (even just 8-10 minutes daily).

• Prioritise self-regulation rituals such as journaling and reading before bed.

4. Sleep as Hormonal Therapy:

Sleep deprivation increases insulin resistance and sebum production. Please prioritise your sleep for optimal PCOS management and for your overall health. Aim for 7-9 hours per night. 

Sleep routine:

• Routine routine routine. Try and maintain a consistent sleep and wake cycle to help your circadian rhythm and optimise your sleep.

• Get sunlight on your eyes first thing in the morning to help reinforce circadian rhythm.

• Limit evening screen time and instead incorporate activities to help unwind and get ready for sleep. The above stress management suggestions are great here.

• Avoid caffeine consumption after midday as it can impact your sleep quality.

Step Three: Supplement Support

For many of you, the foundational strategies outlined above are sufficient to restore hormonal balance and significantly improve acne outcomes. However, in certain cases, short-term and clinically guided supplementation can provide additional support for PCOS management by targeting specific metabolic or inflammatory pathways.

If considering supplementation, especially alongside prescribed medication, it is important to seek personalised guidance from qualified healthcare professionals to ensure safety, appropriate dosing, and optimal therapeutic outcomes.

Some supplements we may recommend: 

• Inositol: improves insulin sensitivity and ovulation; reduces androgen levels

• Omega-3 EPA/DHA: anti-inflammatory; supports skin barrier function

• Zinc Picolinate: antimicrobial and sebum-regulating; regulates androgen levels

• Probiotics (strain-specific): gut microbiome support

• Berberine: blood sugar control and improves insulin sensitivity; antioxidant effects

• N-Acetyl Cysteine (NAC): liver detoxification; antioxidant benefits

• Chromium Picolinate: improves insulin sensitivity and blood sugar control; hormone balancing

• Magnesium Glycinate: improves insulin sensitivity; promotes better sleep and mood stability; reduces inflammation and pain