I know firsthand how frustrating PCOS acne can be. You try every skincare product, cut out sugar, drink more water, and yet the breakouts keep coming. It is exhausting. The truth is, PCOS acne is not just a surface-level issue—it is driven by hormonal imbalances and insulin resistance, which means fixing it starts from the inside out.
If you have been struggling with stubborn breakouts along your jawline or lower face, it is likely linked to high insulin levels and elevated androgens (male hormones like testosterone). Understanding why this happens is the key to clearing your skin for good.
Why PCOS Triggers Acne
PCOS is a hormonal condition that affects everything from metabolism to fertility, but one of the most frustrating symptoms is acne. This happens because PCOS is often accompanied by elevated insulin and testosterone levels, which stimulate your skin to produce more oil. More oil means clogged pores, and clogged pores lead to breakouts.
Even if your blood sugar looks normal, insulin resistance can still be driving your acne. When insulin levels are high, they send a signal to the ovaries to make more testosterone. That extra testosterone increases oil production, leading to deeper, more stubborn breakouts—especially along the jawline, chin, and neck.
Why Lowering Insulin Levels Can Help
Most people think of insulin only in relation to diabetes, but it plays a huge role in hormone regulation too. If insulin is too high, testosterone levels go up, and acne flares. This means that the most effective way to clear your skin is to lower insulin levels through a Low Insulin Lifestyle.
By keeping insulin in check, you can:
- Reduce testosterone production (which means less oil and fewer breakouts)
- Lower inflammation (which helps prevent those painful cystic breakouts)
- Balance hormones naturally, rather than relying on temporary fixes
This is why a Low Insulin Lifestyle is one of the most powerful ways to heal your skin from the inside out.
The Hormonal Chain Reaction Behind PCOS Acne
PCOS acne is not random. It is part of a hormonal domino effect.
- Insulin resistance leads to high insulin levels
- High insulin triggers the ovaries to make more testosterone
- Testosterone increases oil production, leading to clogged pores and acne
For some women, genetics play a role too. Certain genes can make your theca cells in the ovaries extra sensitive to insulin, meaning they produce even more testosterone, which is often seen in women with Lean PCOS. If this runs in your family, your skin might be even more reactive to insulin spikes.
How to Manage PCOS Acne Through Diet
The foods you eat have a direct impact on your insulin levels, regardless of your weight. This means these foods also have an impact on your skin.
If you are dealing with PCOS acne, the biggest culprits to avoid are:
- Starches like rice, bread, pasta, and potatoes
- Sugar in sweets, sodas, and most packaged foods, as well as honey, maple syrup, and coconut sugar (sugar is sugar)
- Milk and whey protein, which spike insulin more than table sugar
On the other hand, choosing foods that keep insulin levels low can help clear your skin. This includes:
- Lean proteins like eggs, poultry, and seafood and plant-based options like edamame and lupini beans
- Non-starchy vegetables like carrots, tomatoes, and broccoli
- Healthy fats from nuts, seeds, and olive oil
- Whole fruits like apples, pears, and peaches
- Fermented dairy like Greek yogurt and aged cheese instead of non-fermented dairy or whey protein
When you eat this way, your insulin levels start to normalize, testosterone production decreases, and your skin can finally calm down.
The Right Skincare Approach for PCOS Acne
Skincare is important, but you cannot scrub away hormonal acne. If your breakouts are caused by internal imbalances, you need to address those first. That said, the right skincare routine can still help manage symptoms while your hormones stabilize.
Do:
- Use gentle, non-stripping cleansers
- Moisturize daily to keep skin hydrated
- Look for ingredients like niacinamide and azelaic acid, which help reduce oil production and inflammation
Don’t:
- Over-wash your face (this just makes your skin produce more oil)
- Use harsh scrubs or drying treatments that can make inflammation worse
- Rely only on topical treatments without addressing the root cause
Ask Your Healthcare Provider About Topical Metformin
Most people think of metformin as just an oral medication for insulin resistance, but it can also be used topically for acne. Metformin helps lower insulin levels, reduce inflammation, and regulate oil production both locally and throughout your body. For some women with PCOS, topical metformin can be a game-changer for acne.
Topical metformin works by:
- Reducing androgen activity in the skin (which means less oil and fewer clogged pores)
- Decreasing inflammation to calm down active breakouts
- Improving insulin signaling at the skin level, helping to balance hormone activity locally
It is not available at most regular pharmacies, but it can be ordered from several mail-order compounding pharmacies with a prescription from your doctor. If you are struggling with hormonal acne, ask your healthcare provider if topical metformin might be a good option for you.
Stress, Exercise, and PCOS Acne
PCOS acne is not just about food—stress and movement also play a role.
- High stress increases cortisol, which raises insulin and makes breakouts worse. Managing stress through activities like walking, deep breathing, or journaling can help keep hormones in check.
- Exercise can help lower insulin levels, but too much cardio can backfire. Strength training, yoga, or daily walks are better for PCOS than excessive high-intensity workouts.
Common Myths About PCOS Acne
Myth: PCOS acne is just like regular acne.
Truth: PCOS acne is driven by hormones, so it does not always respond to traditional acne treatments.
Myth: You just need to wash your face more often.
Truth: PCOS acne is not about hygiene—it is about internal imbalances. Over-cleansing can actually make things worse.
Myth: Prescription acne medications will fix the problem.
Truth: Medications like Accutane, birth control, or spironolactone can help in the short term, but if insulin resistance is not addressed, acne often comes back.
Myth: Diet does not affect acne.
Truth: The foods you eat directly impact insulin, testosterone, and oil production. A Low Insulin Lifestlye is one of the most powerful acne treatments.
Taking Control of PCOS Acne
If you have been struggling with acne for years, it is not your fault. PCOS acne is complex, and it takes more than a good face wash to fix it. But by focusing on insulin first, you can start healing from the inside out.
- If you have not checked your insulin levels, that is step one.
- A Low Insulin Lifestyle can help clear your skin naturally by balancing hormones at the source.
- Skincare, stress management, and exercise all play a role, but none of them will work if insulin levels are too high.
If you are tired of battling hormonal acne and want to get to the root cause, start by managing insulin. Your skin—and your overall health—will thank you.
References
Emiroğlu N, Cengiz FP, Kemeriz F. Insulin resistance in severe acne vulgaris. Postepy Dermatol Alergol. 2015. Read more
Sadowska-Przytocka A, et al. Insulin resistance in the course of acne – literature review. Postepy Dermatol Alergol. 2022. Read more
