Skin Issues Due To Polycystic Ovary Syndrome
Polycystic Ovary Syndrome or PCOS is an endocrine disorder with a prevalence of about 9.1 per cent among Indian teenagers. It is characterized by less frequent periods, obesity, infertility and skin changes due to excessive male hormones. Though the patient may have menstrual irregularities, it is usually a dermatologist who suspects and diagnoses PCOS, as the patient’s complaints will mostly be with regard to skin and hair problems. This may be a cosmetic concern for the patient, but PCOS can also be associated with diabetes, hyperlipidemia and the risk of heart disease. Here are some skin problems that should alert you about an underlying hormonal issue.
Unlike regular acne or pimples, acne in a female with PCOS is stubborn and does not respond well to the usual medications, either topical or oral. Even if the patient initially responds to treatment, the pimples promptly recur on stopping the same. They may also have a flare up before each menstrual cycle. The pimples which tend to occur along the jaw line and the chin are often large, nodular and cystic leaving behind scars.
Hirsutism refers to thick, coarse hair occurring on the chin/upper lip and chest areas (male pattern distribution) in females. This is a very embarrassing problem that causes significant distress to the patient. It occurs due to excessive male hormones produced by the ovaries in PCOS. Many females are deeply disturbed by the male-like beard hair and can suffer from psychological problems due to this. Moreover, the frequent removal of the thick hair on the chin and beard area by shaving, waxing, and epilation can result in bumps, infection, and scars.
Excessive male hormones produced in PCOS also leads to hair loss. This type of hair loss, referred to as ‘female pattern hair loss’ is similar to males going bald under the influence of the hormone testosterone and its derivatives. The hair loss is gradual and occurs around the partition and the sides of the scalp (temporal areas). Gradually, the hair thins out, making the scalp visible. Therefore, many women resort to the use of commercially available hair fibres to cover up the visible scalp.
PCOS is now considered as a metabolic disorder associated with insulin resistance and a risk of developing Type Il diabetes mellitus. Acanthosis nigricans refers to dark, thick and velvety skin seen around the neck, underarms and the groin folds. This occurs as a result of increased levels of insulin in the blood that acts on certain receptors in the skin, stimulating excess growth and pigmentation of it. Sometimes, the patient complains of becoming darker over months or years, which is often attributed to sun exposure and tanning. However, despite using a good sunscreen, the complexion does not seem to improve.
These are skin outgrowths often seen on the neck and underarm area and is commonly associated with acanthosis nigricans.
A dermatologist may suspect PCOS if a patient has resistant acne with or without other signs of hyperandrogenism
Tackling Skin Issues Due To PCOS
- In PCOS, the skin merely reflects the imbalance in the internal hormonal milieu
- A dermatologist may suspect PCOS if the patient has resistant acne with or without other signs Of hyperandrogenism
- A blood test and a pelvic scan are commonly conducted to confirm the diagnosis of PCOS, after which treatment can be sought
- In addition to regular acne treatment, oral contraceptives are helpful in regulating the hormones to bring the acne under control
- Oral metformin, an anti-diabetic drug helps in reducing insulin resistance and decrease skin pigmentation and thickness
Certain medicines are used to tackle hirsutism in addition to procedures like laser hair reduction. However, due to underlying hyperandrogenism, laser hair reduction alone may not provide good results for hirsutism and hence it has to be combined with oral anti-androgens.
Lifestyle modifications with regular exercise, healthy diet, and weight reduction forms a very important aspect in the treatment of PCOS, which in turn helps in improving skin problems associated with the same, Diet should include foods with a low glycemic index and high fibre. Further, acanthosis nigricans improves only when topical medications are coupled with weight reduction.
Due to the complex pathogenesis of PCOS, a multi-specialty approach involving the dermatologist, gynaecologist, endocrinologist, and the dietician helps in successful management of skin problems caused due to this hormonal disorder.