PMOS AND THE SKIN
PCOS has a new name, but what do aesthetic practitioners need to know about how the condition shows up on patients’ skin?
PMOS (polyendocrine metabolic ovarian syndrome) is the new name for the condition formerly known as polycystic ovary syndrome (PCOS), adopted following a global multistakeholder consensus process. The rename reflects the condition's endocrine and metabolic breadth rather than simply an ovarian-cyst-centred model, but the underlying pathophysiology and skin findings described in pre-2026 literatureremain valid.
WHAT IS PMOS?
PMOS is a common endocrine-metabolic condition affecting an estimated 6–21% of women of reproductive age. Despite the historical name, ovarian "cysts" are neither a feature in the condition nor diagnostic of it. One of the reasons for the change of name was the fact that without having cysts on the ovaries, many women missed out on a diagnosis. We know now that 70% of women are never diagnosed.
WHAT CAUSES IT?
The precise aetiology is unresolved. Excess ovarian and adrenal androgen production, with elevated androgens drive the visible features we see. Second, insulin resistance is present in most affected women, and elevated insulin appears to amplify androgen output; this resistance can be worsened by diet quality, gut microbiome composition and psychological stress. Longer term, insulin resistance carries an increased risk of adverse pregnancy outcomes, type 2 diabetes and cardiovascular disease. Hyperandrogenism and insulin resistance together account for the skin features.
DOES PMOS HAVE SPECIFIC SKIN SIGNS?
There are typical skin features that crop up early in the condition.
• Acne. This is the most common cutaneous feature, affecting over three-quarters of women and girls with the condition.
Androgens upregulate sebaceous gland activity and sebum output, while insulin resistance contributes to epidermal hyperproliferation. These mechanisms create a recognisable skin profile that can precede diagnosis.Acne are typically distributed over the chin, jawline, cheeks, forehead, trunk and nose.
• Hirsutism. Androgen-driven terminal hair growth in a male-pattern distribution, often accompanied by androgenic alopecia.
• Acanthosis nigricans. These velvety hyperpigmented plaques at the neck, axillae and groin are closely linked to insulin resistance and obesity rather than androgen levels per se.
• Skin tags. These benign fibroepithelial polyps in flexural sites, are reported in around one in five affected women. Acne pathogenesis, whether or not it coincides with PMOS is multifactorial. Follicular hyperkeratinisation, androgen-driven sebum overproduction, Cutibacterium acnes proliferation and inflammation occur together.
TREATING PMOS SKIN CONCERNS
Acne vulgaris is more than a cosmetic issue; it is a common, often distressing manifestation of PMOS. Management works best when endocrine regulation is combined with standard dermatological care. Systemic/hormonal: Combined oral contraceptives remain first-line for regulating cycles and lowering circulating androgens; anti-androgens are added or substituted where the pill is contraindicated or insufficient. Metformin, long used as an insulin sensitiser in this population, has specific trial evidence for improving acne. Topical, for acne: Retinoids and niacinamide address hyperkeratinisation and barrier function; alpha- and poly-hydroxy acids provide keratolytic exfoliation with evidence for efficacy in acne, with PHAs offering comparable benefit with less irritation than AHAs. Topical salicylic acid helps reduce acne by exfoliating the skin, keeping pores clear, and providing anti-inflammatory and bacteriostatic effects.
Daily non-comedogenic, zinc-based broad-spectrum sunscreen is recommended given the pro-inflammatory effect of UV exposure; zinc additionally has antibacterial and sebum-reducing properties. Ceramide-containing moisturisers are increasingly supported for barrier restoration in acne-prone skin. Benzoyl peroxide remains effective as a targeted spot treatment against C. acnes but carries a high rate of local irritation, limiting first-line use. Procedural: it can bypass the skin’s stratum corneum, which forms the skin barrier, to allow actives to be placed efficiently and directly into the epidermis. Studies show that actives delivered with microneedles are more effective than actives on the skin. Acanthosis nigricans: Management should prioritise the underlying insulin resistance via lifestyle intervention and metformin, which produces visible skin improvement over time; topical retinoids reduce pigmentation and urea or salicylic acid improve textural thickening, with chemical peels an option of variable benefit.
THE TAKE-HOME FOR PRACTITIONERS
The 2026 rename doesn't change clinical management, but it is a useful cue to revisit patient-facing language and documentation. Skin findings in PMOS are frequently the presenting complaint and a legitimate entry point for metabolic screening and referral.
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DR GINNI MANSBERG
Dr Ginni Mansberg is a GP, TV presenter, podcaster, author and columnist. She is a physician specialising in women’s health, menopause and all things skin. She is also the co-founder and medical director of science-based cosmeceutical skincare brand, ESK.