PMOS/PCOS Acne: Why It Happens

More Than Skincare

If you’ve tried different cleansers and spot treatments without lasting improvement, you may wonder whether something beyond your skincare routine is contributing to your acne.

For some people with PCOS/PMOS, hormonal changes play an important role. Higher androgen levels, or skin that is particularly sensitive to androgens, can increase oil production and make pores more prone to blockage.

But acne is multifactorial. Hormones are part of the picture, not the entire explanation. Having acne does not automatically mean you have insulin resistance, and persistent breakouts are not proof that your skincare routine is wrong.

PMOS/PCOS Acne: How Hormones Can Contribute

Acne develops through several interacting processes: excess sebum, the buildup of skin cells inside hair follicles, changes in the follicular environment and inflammation involving Cutibacterium acnes, a bacterium normally found on the skin.

In PCOS/PMOS, androgens can influence this process in a few ways.

1. Increased oil production

Androgens such as testosterone and dihydrotestosterone can stimulate sebaceous glands to produce more sebum. Individual skin sensitivity matters, so acne severity does not always correspond directly to blood testosterone levels.

2. Insulin and SHBG

In some people with PCOS/PMOS, insulin resistance is associated with higher circulating insulin. Insulin can stimulate ovarian androgen production and reduce the liver’s production of sex hormone-binding globulin (SHBG), a protein that binds sex hormones in the blood. Lower SHBG can increase the proportion of testosterone that is available to tissues.

This is one possible pathway linking metabolic and hormonal changes to acne, but it does not occur to the same degree in everyone.

3. Blocked pores and inflammation

Excess sebum and abnormal shedding of cells within the hair follicle can contribute to clogged pores. Inflammatory responses then produce the red, swollen or painful lesions associated with acne.

Breakouts often appear on the lower face and jawline in adults with hormonal acne, but location alone cannot establish that hormones or PCOS/PMOS are responsible.

What Does Current Evidence Say?

A 2025 review of PCOS-associated acne describes the interaction between androgen excess, insulin resistance and skin inflammation. However, much of the mechanistic evidence explains biological plausibility rather than proving the cause of acne in any individual.

The practical takeaway is that treatment should address the acne itself while considering hormonal or metabolic contributors when appropriate.

Topical retinoids, benzoyl peroxide and azelaic acid are among established acne treatments. Depending on the person’s symptoms, medical history and preferences, a clinician may also consider hormonal treatment. Metformin may be appropriate for selected metabolic indications in PCOS/PMOS, but it should not be assumed to be a first-line acne treatment for everyone.

Persistent, painful or scarring acne deserves medical assessment rather than repeated experimentation with skincare products alone.

A Practical Tip

Keep your routine simple and consistent, and introduce new products cautiously. If your acne persists, note when it started, how severe it is, whether your periods are irregular, and whether you’ve noticed other changes such as increased facial hair or scalp hair thinning.

These details can help a healthcare professional decide whether an assessment for hormonal contributors is appropriate. Do not assume that a particular meal caused a breakout based only on its timing.

Your HeyTimi Action

Use HeyTimi’s existing symptom and cycle logs to record relevant changes over time. If you’re experiencing persistent acne alongside irregular cycles or other possible signs of androgen excess, bring those observations to a healthcare appointment.

Tracking can help organise your observations, but it cannot diagnose the cause of acne or confirm insulin resistance. A clinician can help determine whether further assessment or treatment is needed.

Medical Sources

1. Damoulaki et al. (2025). Polycystic Ovary Syndrome-Associated Acne: The Interplay of Hyperandrogenism, Insulin Resistance, and Therapeutic Strategies. A recent review of proposed mechanisms and treatment approaches. Read the review.
2. National Institute for Health and Care Excellence (NICE). Acne vulgaris: management. Guidance updated in April 2026, including recommendations for acne in people with PCOS. Read the guidance.
3. American Academy of Dermatology. Guidelines of care for the management of acne vulgaris. Evidence-based recommendations for topical and systemic acne treatments. Read the guideline.
4. Teede HJ, et al. (2023). Recommendations From the International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. An important clinical guideline for the broader assessment and management of PCOS. Read the guideline.