Here’s What PCOS Acne Looks Like—and How to Treat It

Any chronic condition can be an emotional journey, and polycystic ovary syndrome (PCOS) is no exception. Its effects on the body are often so visible, it’s no wonder why it can take such a heavy toll. High up on its frustrating list of symptoms? Deep-rooted, tender-to-the-touch acne.

Despite the focus on “ovary” in the name, PCOS doesn’t just affect one part of your body, Lekshmi Nair, MD, an assistant clinical professor of internal medicine who specializes in endocrinology and PCOS at The Ohio State University Wexner Medical Center, tells SELF.

It certainly stirs up chaos in your reproductive system, but it can mess with your skin and hair, sleep, metabolism, and cardiovascular health, too. That’s because women with PCOS usually have higher-than-normal levels of hormones called androgens, which can prompt body-wide ripple effects. (Androgens, including testosterone, are known as “male” hormones, but everyone has them and needs them.)

Skin symptoms are such a biggie because so many women struggle with adult acne, which is often fueled by hormonal fluctuations. So, how can you know if your chin zits are a glaring sign of PCOS versus another, more common cause of stubborn breakouts? Here’s what experts want you to know, including what PCOS acne looks like, other ways the condition affects your skin, and the treatments that can help you feel better—inside and out.

Why does PCOS cause acne?

Experts generally agree that you need to meet two out of three criteria to be diagnosed with PCOS. For starters, the condition typically disrupts and sometimes prevents ovulation, or when an ovary releases a mature egg about halfway through a 28-day menstrual cycle. This can manifest as irregular periods, heavy or painful periods, super-long periods, or no period at all.

That ties in with the second clue: These eggs may not be released or grow as they should (a major reason why PCOS is associated with fertility struggles). That can lead to what looks like a “string of pearls” along the outer edge of your ovary, Dr. Nair explains, which your ob-gyn can see on an imaging test called an ultrasound. While these fluid-filled sacs are often called “cysts,” they’re actually tiny follicles, and each contains a single egg that didn’t develop properly.

Dr. Nair says the third tip-off is a collection of skin symptoms triggered by those high androgen levels, known as hyperandrogenism. This often includes acne and growing hair in places that aren’t typical for you (more on this later). Excess androgens stimulate your sebaceous glands (oil glands) to produce more sebum (oil), Amy Freedman, MD, a board-certified dermatologist at Schweiger Dermatology Group in New York City, tells SELF. The oil mixes with dead skin cells and clogs your hair follicles, creating the ideal environment for inflammation-causing bacteria called C. acnes. Cue the annoying zits!

A few things can tip you off that your acne may be related to PCOS.

PCOS-related acne falls under the hormonal acne umbrella. While this term isn’t an official medical diagnosis, dermatologists use it to describe breakouts that sync up with hormonal fluctuations caused by a person’s menstrual cycle, heavy stress (thanks, cortisol), or a chronic health condition. Here’s what to look out for:

You’re well beyond puberty.

Research suggests that about 20% of women deal with adult acne, even if they were lucky enough to avoid the pasty pimple cream as teens. Of course, not all of those women have PCOS, but it’s worth flagging to your doctor if you’re breaking out and dealing with other signs of the condition, Dr. Nair says. Acne can crop up in your 20s and beyond because reproductive hormones rev up as your body edges closer to its peak fertile window. That said, breakouts can also strike women later in life during perimenopause and menopause (*sobs*) as a fresh wave of hormonal mayhem occurs.

Your zits cluster on the lower half of your face.

Dr. Freedman says your cheeks, chin, and jawline are hot spots for hormonal acne because they’re more concentrated with oil glands. You may notice breakouts on your chest and back, too, Dr. Nair adds.

Your pimples look and feel super angry.

Whiteheads and blackheads are more surface-level than hormonal acne. With PCOS, you’re more likely to develop deep pimples, papules, or cysts thanks to the inflammation happening far inside the follicles next to your oil glands. These bumps will feel tender or painful to the touch and look highly irritated. Think: vibrant pink and red spots in fairer skin tones, and more hyperpigmented marks in deeper skin tones, Dr. Freedman notes.

Your breakouts take forever to heal.

Hormonal acne is “definitely a little more persistent than regular acne,” Dr. Freedman notes. Because the breakouts stem from deep beneath the skin, they don’t always respond to OTC treatment alone and usually take longer to go away. When the pimples do start to heal, they can also leave lasting marks; pitted or indented scarring is more common in lighter skin tones, while raised scarring shows up more in deeper skin tones, Dr. Freedman says.

What do other PCOS-related skin symptoms look like?

The tricky thing about acne is that it has so many potential causes, so it’s not a strong marker of PCOS as a solo symptom, Dr. Nair says. If your doctor suspects that you’re dealing with hyperandrogenism, they’ll likely be looking for the following symptoms, too.

Hirsutism

Dr. Nair says hirsutism, or hair growth that shows up in areas you don’t usually expect it to, is a hallmark sign of PCOS (affecting up to 70% of people with the condition) because it grows in areas of the body that are more dependent on androgens. Of course, we all sprout a randomly long chin hair from time to time, (societal beauty standards be damned). Hirsutism, however, is defined as “excessive” hair growth, which can mean different things to different people—your “too much” may be another person’s “average,” for example.