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 it happens 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, superlong 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 Freeman, 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:

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.

Dr. Freeman 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.

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. Freeman notes.

Hormonal acne is “definitely a little more persistent than regular acne,” Dr. Freeman 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. Freeman 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.

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.

As for how this hair tends to show up? Again, that depends on the individual, but the strands are usually thicker or coarser than the rest of the “normal” hair on your body, and can appear more abundantly on your face, chest, back, upper arms, lower abdomen, or lower legs.

Acanthosis nigricans is a skin condition that usually signals insulin resistance, which commonly occurs alongside a potential complication of PCOS, Dr. Nair says. This means cells in the body don’t respond to insulin as they should due to consistently high blood sugar levels. “More than 50% of women with PCOS have insulin resistance, so it can clue you in,” she notes. (Researchers are still trying to understand the root cause of this connection, but suspect the hormonal shifts, genetics, a higher body fat percentage, and inflammation can all play a role.)

Typically, acanthosis nigricans will look like darkened, velvety patches that may have visible crease marks because they appear in areas where the skin folds, like your underarms, inner thighs, or the back of the neck, Dr. Freeman says. Why? Insulin or insulin-like substances speed up the growth of keratin, a key protein in your skin. We don’t have a ton of concrete data on who’s more susceptible to these changes and why, but Dr. Nair notes that it’s more prevalent among her patients with deeper skin tones.

Here’s how to treat PCOS-related acne and other symptoms.

The core steps in your skincare routine—cleanser, moisturizer, and sunscreen—can make a big difference in how your complexion looks and feels. For each, you’ll want to look for “oil-free” and “noncomedogenic” on the labels, which means the products are designed to minimize the chances of clogging your pores even further, Dr. Freeman says.

Cleansing after you wake up and before you go to bed is plenty—any more than that, and you run the risk of drying out your skin, which can encourage it to produce more oil, she explains. Some people with very inflamed, sensitive, or flaky skin prefer gentler, creamy washes, while others who get very oily may prefer a foamier formula.

Moisturizers and sunscreens with thinner, gel-like consistencies also feel lighter on the skin. It’s tempting to skip these steps because it can feel like you’re adding grease to the fire (literally), but acne-prone skin still needs hydration and sun protection, both for the health of your skin barrier and to reduce the risk of scarring and hyperpigmentation.

Dr. Freeman prefers mineral sunscreens, which are made with zinc oxide and titanium oxide, because they’re usually less irritating for sensitive complexions. However, “the best sunscreen is the one you’re going to use,” she stresses. So find a broad-spectrum SPF that you actually like and be diligent about applying it.

“Actives” claim to treat a specific skin issue, and they can be immensely helpful in improving acne. There are a bunch of OTC ingredients to choose from, and each requires some cautious experimentation. Dr. Freeman typically recommends starting with the following picks for her patients with hormonal breakouts:

• Benzoyl peroxide: This is one of the best OTC ingredients we have to kill acne-causing bacteria and reduce inflammation. You can find it in face washes and spot treatments. Start with 2.5% to minimize the risk of irritation and work your way up to 5 to 10% if your skin tolerates it well.
• Salicylic acid: If your skin isn’t responding to benzoyl peroxide, consider a 2% salicylic acid wash or treatment. It’ll gently exfoliate your skin, helping to unclog pores and tamp down on oil.
• Azelaic acid: This ingredient can be a game-changer for sensitive skin. It also does a great job of quelling inflammation, unclogging pores, minimizing redness, and fading dark spots.
• Topical retinoids: These vitamin A derivatives are a go-to for hormonal acne because they speed up skin cell turnover, which unclogs pores and smooths texture. You can start with OTC retinol products like adapalene (Differin) or talk to your dermatologist about prescription-strength options, like tretinoin, or an oral retinoid like Accutane (isotretinoin), (which is highly effective but a big commitment). It can take your skin a while to adjust to any retinoid, often leading to more irritation before you see results, so it’s worth speaking with a derm about the best route for you.

If it seems like you’ve tried every skincare product under the sun and nothing is clearing your pimples up, check in with your doctor, whether that be a board-certified dermatologist, ob-gyn, or endocrinologist. They can guide you on how to target your most persistent PCOS symptoms, acne and other skin woes included.

There aren’t any FDA-approved treatments designed for PCOS specifically, Dr. Nair explains, but specialists have various medications at their disposal to help regulate hormonal fluctuations, reduce the effects of hyperandrogenism, and treat insulin resistance. They’ll likely start with one of these options:

Think of this as a form of hormonal therapy, Dr. Nair says. In combination pills, synthetic forms of estrogen and progesterone join forces to stabilize your hormones. Not only does this help “reset” your menstrual cycle, easing any unpredictability you have with your period, but it also blunts the effect of excess androgens, which can reduce hormonal acne and the effects of hirsutism, she explains.

Birth control pills can be beneficial in other ways, too. If you are going months without a period, you’re not regularly shedding your uterine lining, Dr. Nair explains. The buildup of that tissue can predispose you to abnormalities that have been linked to an increased risk for endometrial cancer. “So if you use birth control pills, you’re preventing that uterine lining from becoming overgrown,” she says.

Anti-androgen medications, like spironolactone, block the effects of androgens in the body, including your skin. In fact, a 2023 study of more than 300 women who struggled with persistent acne found that spironolactone significantly improved their complexion after long-term use. It may be prescribed in tandem with birth control pills and can take up to three months to start seeing visible improvement in your skin, Dr. Freeman notes.

Metformin is used to improve insulin resistance and control blood sugar, so it often comes into play with PCOS, Dr. Nair says. Research shows the drug can significantly reduce androgen levels, get menstrual cycles back on track, and improve insulin sensitivity when used to treat PCOS specifically. All of this can have a ripple effect, reducing the severity of acne, acanthosis nigricans, and hirsutism, too.

Working closely with a doctor you trust is critical in managing your PCOS symptoms and all the emotions they can stir up. Not only do you want to treat your current symptoms, but you also want to make a game plan for reducing your risk of health complications in the future. So, on top of prescription meds, your doctor may also suggest making certain lifestyle changes—like working with a therapist to get a grip on your stress, or a dietitian to reduce your insulin spikes with a low-glycemic diet—as part of a holistic care plan.

No two people with PCOS have an identical experience, so be real with your doctor when something isn’t working. A little hope (and a lot of patience) can go a long way. “There are great treatments out there, so don’t get discouraged,” Dr. Freeman says. “If one treatment doesn’t work, there’s always another we can try.”

Related:

• The Mental Health Effects of Acne Are Very, Very Real
• What Does Estrogen Do in the Brain? A Lot More Than You May Realize
• 6 Things a Wonky Period Might Be Telling You About Your Health

Get more of SELF's great service journalism delivered right to your inbox.