Evidenced-based nutritional therapy for the management of acne vulgaris in women with polycystic ovary syndrome

Acne is the most common skin condition affecting adolescents and polycystic ovary syndrome (PCOS) is the most common endocrine abnormality affecting reproductive age women often becoming apparent during adolescence. Population-based studies have estimated that 30-40% of women with PCOS have acne of variable severity. Acne is usually perceived as a clinical symptom or cosmetic problem and treated with topical or systemic medical therapies that have variable efficacy and the potential for significant side-effects. There is emerging evidence that acne is a lifestyle-driven disease of modern civilisation that is a cutaneous biomarker for underlying metabolic and hormonal abnormalities. Insulin resistance has increasingly been recognized as a core pathophysiological feature of both PCOS and acne. The appearance of acne may therefore provide a window of opportunity for the early diagnosis of PCOS and insulin resistance. Early diagnosis may allow the implementation of preventative strategies to reduce the associated cosmetic (scarring), psychological (depression, anxiety) and medical morbidity (diabetes, metabolic syndrome). Nutritional factors play a significant role in the pathophysiology of both acne and PCOS and have been shown to be effective therapeutic interventions. As a result, the International Guidelines recommend that dietary modification should be the first-line of treatment for all women with PCOS. The currently available evidence supports the recommendation that nutritional therapy should be the first-line of management for all adolescents and women with PCOS and acne.