PCOS, or polycystic ovary syndrome, is one of the most common hormonal disorders among women of reproductive age, and it has no known cause. Among its symptoms include irregular or no period at all, weight gain, either hair loss or excessive growth, and oily skin. It is also commonly linked to female infertility. One of the main physical manifestations of PCOS is acne. How can you tell if it's just a regular breakout or already a tell-tale sign of the disorder and what can you do to make them go away? We consulted with two experts: Dr. Ron Michael Dagala, M.D., DPDS, and Dr. Nini Infortuno-Sana, OB-GYN to answer these important questions. Read on to learn more:
How does PCOS trigger acne?
Polycystic Ovarian Syndrome or PCOS is a hormonal condition that is commonly seen in women of reproductive or childbearing age. It is believed to be caused by a multitude of factors, commonly by genetic or metabolic causes.
These patients do not make sufficient hormones needed for ovulation. When ovulation does not happen, small cysts form in the ovaries. These cysts produce the androgens (male hormones), in excessive levels cause irregularities in menses as well as the many symptoms that are seen in PCOS. TL;DR: Male hormones are usually seen in small amounts in females, but when one has PCOS, there is an increase in production.
So how does PCOS cause acne? The increased levels of androgens stimulate your oil glands to produce excessive amounts of oil. This overproduction causes your pores to get clogged and inflamed, therefore resulting in pimples.
What are the other physical manifestations of PCOS?
Aside from acne, PCOS has a number of physical manifestations.
Irregularities in the menstrual cycle
This can either be missed menses for a couple of months (amenorrhea) or decreased or irregular menses within a year (oligomenorrhea). Patients have large ovaries or have many cysts in the ovaries. This can be seen via ultrasound.
Excessive growth of body hair
Patients may also have hirsutism or excessive growth of body hair. This is usually seen in the male distribution pattern: Women may have hair growth in areas that are more commonly seen in men, like the upper lip, chin, chest, nipples, lower abdomen, and back.
Although an infrequent finding, patients may also experience thinning of hair or female-pattern baldness.
Dark and thickened patches of skin
Other dermatologic manifestations of PCOS include acanthosis nigricans or the dark and thickened patches of skin in the flexural areas, like the back of the neck, underarms, groin, abdominal folds and under the breasts. This may also be accompanied by an increase in "skin tags," or small pieces of excess skin in the same areas mentioned.
Because of androgen excess and the metabolic state resulting from it (insulin resistance), these patients are usually obese and are prone to have increased blood pressure and diabetes.
PCOS may also have a psychological impact on patients. Depression, anxiety, and even eating disorders are sometimes seen.
What are the differences between regular acne and PCOS-related acne?
On examination, the physical difference between common acne and hormonal acne is actually minimal to none. Both may manifest with inflammatory lesions or red papules, pustules, nodules, and cysts found on the face, neck, chest, and back. The onset of hormonal acne, however, tends to originate or persist into adulthood. Another clue is a poor or slow response to usual acne treatment. And last but not the least, irregular menses, or the presence of other physical manifestations of PCOS mentioned above will strongly suggest hormonal acne. So it goes without saying that it is of utmost importance to have a consultation with a board-certified dermatologist, as well as your gynecologist, to make a definitive assessment.
What's the best way to treat PCOS-related acne?
Treatment is based on your age, acne severity, and general health. It also differs if a patient desires pregnancy. Standard acne therapy is recommended for hormonal acne. These include topical retinoids, topical and oral antibiotics, and if needed, peels and oral isotretinoin. What you need among these is decided upon only by your dermatologist. If you need any help, there are tons of clinics that offer online consultations during quarantine such as Skin House Beauty and Laser Clinic that can suggest products and treatments for your budget. A basic skincare regimen must still be practiced.
Hormonal therapy plays a role in PCOS-related acne. This may include oral contraceptives, anti-androgens, and sometimes even diabetes medication, all of which depend on your current condition and needs. Again, these are decided only by your dermatologist and/or gynecologist.
Lastly, lifestyle change is also crucial in the improvement of hormonal acne. This includes a healthy diet, weight loss, and exercise. These will help address the hormonal and metabolic aspects of PCOS.
The bottom line
In conclusion, the best way to manage hormonal acne is to be seen by both your dermatologist and gynecologist, and have the necessary workup and assessment before starting the medication. This will not only increase the efficacy of the treatment but also offer a more holistic approach to what a patient really needs. Again, there are no shortcuts, consult your doctors for a guided, and effective treatment plan. Never self-medicate!
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