The real culprit, especially in women who have PCOS, is sugar. Excess sugar in the bloodstream has a peculiar effect on the ovaries. It stimulates them to make testosterone. This is the masculinizing hormone that also causes hair growth and mood swings. Unlike most tissues in the body, the ovaries don't have a way to protect themselves against high blood sugars. The sugar floods in and various hormone manufacturing processes rev up. Instead of making a tiny amount of testosterone, the ovaries make a lot. This testosterone travels to the skin. It encourages the skin to get tougher and thicker. The skin can grow right over the top of a pore, sealing oily sebum and bacteria inside. This makes a whitehead, the most common kind of acne in PCOS. Whiteheads, of course, can get infected and cause pimples and cysts.
Women who have PCOS acne of course need to cleanse the skin-but washing too often is as bad as not washing enough. Scrubbing the skin, and exposing it to hot water, causes tiny, invisible flaking. These flakes lodge over pores and create new whiteheads and pimples. It's important not to rub a bar of soap across the skin, but instead to use liquid cleanser applied with clean fingertips. But it's even more important to get the sugar out of your diet. If you reduce sugar calories in your diet, your ovaries will not be as stimulated. They will make less testosterone. This stops new blemishes from forming. It does not cure the old ones. After about 28 days, however, a low-sugar diet begins to make a huge difference in the appearance of your skin. Gentle cleansing and, if needed, treating infected pimples with benzoyl peroxide or tea tree oil can then make PCOS acne a thing of the past.