The largest organ of your body, your skin, is a good reflection of what’s going on inside. If you have naturally smooth, unblemished skin, consider yourself lucky. But if you are a woman with polycystic ovary syndrome (PCOS), you likely have experienced abnormal skin issues that go beyond just simple acne. For women with PCOS, skin challenges you may face could be severe acne, excessive facial or body hair growth, dark patches on the skin, and even hair loss.
PCOS was first recognized in 1935 and is associated with small cysts on the ovaries leading to hormonal imbalances. Women with PCOS can also have insulin resistance increasing the risk for diabetes in addition to developing high blood cholesterol.
PCOS may affect as many as 5 million women in the United States and can occur in girls as young as 11 years old. The cause is unknown but seems to run in families as women with a mother or sister with PCOS are more likely to develop it also. The main issue is a hormonal imbalance where the ovaries are making more androgens (male hormones such as testosterone) than what normally a woman makes. The high androgen levels can lead to various symptoms in women:
- Weight gain
- Excessive hair growth
- Menstrual irregularities – infrequent, and/or absent
- Infertility – PCOS is the most common cause of infertility in women
- Cysts on the ovaries
- Male-pattern baldness or thinning hair
- Skin tags – excess flaps of skin in the armpits or neck area
- Pelvic pain
- Anxiety or depression
- Sleep apnea
- Patches of skin on the neck, arms, breasts, or thighs that are thick and dark brown or black
Diagnosis of PCOS relies on lab tests and imaging. Lab tests are used to measure levels of various hormones, such as androgens. Imaging tests may be used to do an ultrasound of the ovaries looking for ovarian cysts. Treating PCOS often involves an arsenal of doctors experienced with this condition that could include your primary care physician, gynecologist, endocrinologist, and dermatologist.
Examples of skin problems associated with PCOS
The hormone disorder of PCOS is primarily believed caused by insensitivity to the hormone insulin. Besides symptoms such as irregular menstrual cycles, ovulation, and weight gain, women with PCOS often have issues with excessive acne.
The PCOS-related acne tends to flare in areas considered “hormonally sensitive,” such as the cheeks, jawline, chin, and upper neck. Instead of the typical acne of occasional breakouts of whiteheads or blackheads, PCOS acne usually involves larger, more painful-to-the-touch cystic acne, often showing up a week or so before a woman’s menstrual cycle, and sometimes lasting for several weeks. Cystic acne is also more likely to cause scarring, irregularities in skin texture, and long-lasting dark areas on the face.
Women, with cystic acne in the lower third of their face and have irregular periods, should discuss the possibility of PCOS with either their gynecologist or dermatologist. The standard topical acne therapies, such as retinoid gels and creams, typically won’t work for this type of acne. Doctors generally agree that hormonal therapy works best of using either birth control pills or spironolactone. Typically birth control pills that contain both estrogen and progesterone (Estrostep, Ortho Tri-Cyclen, and Yaz) have been FDA approved to treat acne. It usually takes up to at least 3 months to see improvement so sticking with the birth control pills is necessary.
But if birth control pills are not working or their effect is only minor, then spironolactone, a diuretic, is another good treatment choice to consider. It can be used to treat acne in women by targeting the hormonal causes of acne. Though it’s effective and safe for treating acne in women, spironolactone isn’t typically used to treat acne in men because it decrease testosterone and can cause unwanted side effects.
For other skin conditions associated with PCOS, such as excess facial hair growth, dark patches on skin, and hair loss, there are treatments that can significantly improve these issues. For excess facial or body hair growth, this can be treated with laser or electrolysis hair removal sessions. To combat the condition called acanthosis nigricans, which are the dark, velvety areas of skin, usually in skin creases such as around the neck and underarms, the prescription diabetes medication called Merformin used to manage diabetes, can help improve the body’s response to insulin helping reduce these dark patches.
Hair loss of balding or thinning hair in women, usually driven by an excess of testosterone, should be evaluated by a dermatologist for their recommendation on how to treat it. Depending on the cause, they can tell a woman what to expect. Sometimes hair may begin to grow again or it may be as simple as making lifestyle changes (healthier diet, increased exercise, loss of weight if necessary), to allow hair to start re-growing.
The dermatologist may also recommend taking the over-the-counter medication approved by the Food and Drug Administration for female pattern hair loss called minoxidil. This topical treatment can help slow or stop hair loss in about one in four or five women.