From a Dermatologist with Polycystic Ovarian Syndrome
September is Polycystic Ovarian Syndrome (PCOS) Awareness Month. This one is a little near and dear to my heart because I have PCOS. For those unaware of PCOS, it is primarily a disorder of the ovaries, but it affects almost every organ system in the body, including the skin. In dermatology, we often see patients with PCOS who are suffering from the effects of PCOS on the skin. These symptoms can include acne, excessive hair growth on the body, hair loss on the scalp, skin tags and acanthosis nigricans. The good news is the effects of PCOS on the skin can be treated and well-controlled with ongoing therapy to improve quality of life.
Imbalances in hormone levels cause the effects of PCOS on the skin. Many patients with PCOS have elevated levels of Testosterone and Insulin. Today, we’ll discuss how alterations in these hormones are believed to impact the skin, and how to treat the symptoms.
There are a variety of symptoms that make us suspect PCOS. As a dermatologist, I suspect PCOS when I see a younger overweight woman, with acne, excessive hair growth in some places and thinning on the top of the head. Now, I realize this is a big generalization, but if a patient has all of these, I often recommend testing for PCOS. Sometimes, I will order some basic hormonal tests in my office, including Testosterone, Estrogen, and DHEA levels. However, women generally need to see a gynecologist and sometimes an endocrinologist as well to solidify the diagnosis. There is no single, agreed-upon diagnostic test for PCOS. Often it is a constellation of symptoms and bloodwork abnormalities. Now on to the skin…
Acne – In patients with PCOS, acne is driven by excess Androgens, the masculinizing hormones that we as females make to some extent as well. The two primary Androgens are Testosterone produced by the ovaries and DHEA made by the adrenal glands. To antagonize these hormones, we often add an oral medication in addition to a standard acne regimen. Spironolactone is a diuretic that also antagonizes androgen as a side effect. Spironolactone can also affect electrolytes, so we check those soon after starting and periodically once on a maintenance dose. Drospirenone functions similarly and is part of two well know birth control pills, Yasmin and Yaz. Insulin and Insulin like growth factor also likely play a role in acne in patients with PCOS. Overproduction of Insulin can be managed with medications such as metformin. For a more detailed discussion about the effects of sugar and insulin on acne, read our article entitled “Does Chocolate Cause Acne?”
Hair Loss – In PCOS, hair loss is generally seen on the top of the head in the same area where we see male pattern baldness. There often is generalized thinning of the hair as well. These patients often benefit from Spironolactone, Yasmin, or Yaz as a preventive measure. However, generally, it requires Rogaine to jumpstart the hair growth. Use of Rogaine is discussed extensively in our previous “Help. I’m Losing My Hair” post.
Hair Growth – Hirsutism is the scientific term for excessive hair growth. In PCOS, small fine hairs called “vellus hairs” convert into thicker darker “terminal hairs.” This is most commonly seen in the beard area of the face, around the nipples, and on the lower abdomen. Again, oral medications Spironolactone, Yasmin or Yaz and Vaniqa work as a preventive measure helping hairs to convert back or remain as vellus hairs. However, it generally requires hair removal to remove the active terminal hairs. Hair can be temporarily be removed by depilatory creams like Surgicream and Nair or more permanently with Laser. Laser Hair Reduction is more difficult for patients with PCOS as more and more hairs are converted to terminal hairs under hormonal control. In patients with PCOS or other hormonal alterations, it may take more than the standard six treatments to clear an area.
Acanthosis Nigricans – is a thickening of the skin that can be seen on the back of the neck, underarms, groin, elbow, knees, and knuckles. Insulin is the primary hormone, in this case, particularly insulin like growth factor. Metformin, weight loss and a long term low carbohydrate diet, often help get Acanthosis Nigricans under control.
The effects of PCOS extend well beyond the skin. Infertility, diabetes, and heart disease are often more serious medical complications of PCOS. A healthy lower carbohydrate diet, maintaining a healthy weight and exercise are essential in augmenting the medical treatments we have discussed today.
To learn more about PCOS, check out the following resources:
PCOS Challenge newsletter, magazine and more
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