September is Polycystic Ovarian Syndrome (PCOS) Awareness month. Over the years social media has popularized the name recognition of PCOS to be associated with infertility, but the far reaching effects of PCOS on the body are still being discovered today. PCOS can effect not only medical impact but also social and emotional impact on teen girls and women.
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. The effects of PCOS on the skin are caused by imbalances in hormone levels. 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 in patients, but there still is not one definitive lab test that makes the diagnosis. 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 it raises my suspicions. 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 made by the ovaries and DHEA made by the adrenal glands. One newer topical medication, called Winlevi, can be beneficial as it works to antagonize testosterone on the skin. Often oral medications can also help in addition to a standard acne regimen. For women who are not of childbearing age, 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. Drosperinone 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?” LINK needed https://www.wvderm.com/does-chocolate-cause-acne/
Hair Loss – In PCOS, hair loss in 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 article entitled “Top Answers for Rogaine Use” LINK NEEDED https://wvderm.com/top-answers-for-rogaine-minoxidil-use/
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 can be helpful. 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 will take more than the standard 6 treatments to clear an area and ongoing treatments as well.
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 causative hormone, 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 PCOS Awareness Organization https://www.pcosaa.org
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