Polycystic Ovarian Syndrome (PCOS) is a very serious genetic endocrine disorder that affects women and girls. It affects your hormones, metabolism, and reproductive organs. PCOS is the leading cause of female infertility as well as a precursor to many other serious medical conditions such as obesity, type 2 diabetes, heart disease, and endometrial cancer.
The exact cause of PCOS is unknown, but it is closely linked to high levels of hormones like testosterone and insulin. It also tends to run in families, which is why it is believed there is a genetic component to this condition. Often women with PCOS go undiagnosed for years because they don’t realize that their irregular periods, acne, skin tags, and unwanted facial hair are all related and they just try to deal with each symptom separately. While there is no cure for PCOS, there are treatments that can help to minimize some symptoms, and even simply understanding that you have an underlying endocrine disorder can help decrease some of the stress that these symptoms can cause.
Women are typically diagnosed with PCOS when they have at least 2 of the following three symptoms:
- They have polycystic ovaries
- 12 or more follicles are visible on one ovary, OR
- The size of one or both ovaries is increased
- They have hyperandrogenism, determined by:
- They have a type of menstrual dysfunction such as:
- Lack of periods
- Menstrual irregularity
- Lack of ovulation
Based on these criteria, women can be diagnosed with PCOS even if they have regular periods or normal androgen levels. Women with PCOS can experience very different types of symptoms and have very different body types. Often a dermatologist may be the first type of medical provider to clue you in on your diagnosis.
Dermatologic conditions caused by PCOS:
There are many different dermatologic conditions that can be caused by PCOS. Each of these conditions can be seen in other syndromes, or even by themselves, but if you have a few of the following, then you may have PCOS to blame.
- Acne: The excess of testosterone in your body leads to an increase in oil production in your skin, which can clog pores and lead to acne. Often hormonal acne tends to be cystic and along the jawline. While antibiotics can help this type of acne, they are not a wise long-term choice, and recognizing that you have PCOS can help you to realize that your acne treatments need to be safe for the long term because PCOS cannot be cured.
- Hirsutism: The extra testosterone can also lead to excessive hair growth on the face, chest, abdomen, thumbs or toes. Laser Hair Removal is one way to try to combat this hairy issue. Because of the hormonal cause, it may take more sessions than “usual” to treat unwanted hair.
- Androgenetic Alopecia: while extra testosterone can cause hair to grow where you don’t want it, that same excess testosterone can be to blame for your hair NOT growing where you DO want it. Women often experience a thinning of their scalp hair due to PCOS. There are some treatments to try to help slow down this process and sometimes even get it to regrow, like with PRP.
- Skin Tags: Skin tags are benign tumors of the skin consisting of a core of fibers and ducts, nerve and fat cells and covered by epidermis. They are often seen in combination with insulin resistance and obesity. They are also common in women during pregnancy and those with high cholesterol or high blood pressure. Depending on their location, skin tags can usually be removed easily if they are of cosmetic concern, or if they are hurting due to clothing or jewelry rubbing and irritating them.
- Acanthosis Nigricans: Another condition that is associated with insulin resistance and diabetes, acanthosis nigricans is commonly found in the skin fold areas where skin tags are also found. It causes a velvety thickening and darkening of the skin and sometimes people worry they are not cleaning their skin enough and unsuccessfully try to scrub it off. While there is no direct treatment for acanthosis nigricans, a healthy diet and weight loss can sometimes help to improve the appearance, as well as definitely help decrease your risk for developing Type 2 diabetes.
- Hidradenitis Suppurativa: This is an inflammatory condition that can lead to abscesses in the armpits, groin or under the breasts. These bumps may start out as small painless cysts, but over time they get inflamed and swell full of pus and can rupture and lead to unsightly scars. It is most commonly seen in younger women, often in African Americans, and those who smoke or are overweight or obese. Weight loss and cessation of smoking are often the top two recommendations to help with flares, but there are some medications that can help manage hidradenitis as well.
In general, diet and exercise and, in the case of obese patients, weight loss can help PCOS patients to decrease their insulin resistance and help lower their testosterone levels. Sometimes the weight loss can also help to regulate your menstrual cycle. Not all PCOS patients are obese however, so weight loss is not recommended for patients who are not overweight or obese.
Medications like Metformin can also help to decrease insulin resistance and sometimes normalize ovulation. It is also very important to stop smoking in order to reduce the risk of smoking-related complications such as blood clots- this can be a problem for obese sedentary women in general, and especially if they are taking oral contraceptives to try to help treat their PCOS.
Antiandrogenic oral contraceptives not only help to treat menstrual irregularities, but they can also help to treat acne and hirsutism by trying to regulate estrogen and progesterone in the body, helping to check the abundance of testosterone usually seen in PCOS. Spironolactone is a powerful antiandrogen that has also been used in treating acne and hair loss. Isotretinoin can be used to help for severe cases of acne, but women with PCOS must be aware that they have a higher risk of acne recurrence when they are done their course of treatment.
We can treat and manage most of these dermatologic issues here at NOVA Plastic Surgery and Dermatology using a combination of prescriptions and procedures. It is important to have someone recognize that you have underlying PCOS that is causing these conditions because simply treating your acne or your excess body hair and ignoring the underlying cause will not completely solve your issues.