Polycystic ovarian syndrome (PCOS) affects up to 12% of XX people in the US – that’s roughly 5 million! This is a multifaceted syndrome that can cause problems ranging from insulin resistance to irregular periods to infertility. However, some of the most visible signs of PCOS manifest on the skin.
What is PCOS?
PCOS is a set of symptoms resulting from excess hormone production by the ovaries. All of us have a balance of estrogen (“female hormone”) and androgen (“male hormone”). These two families of hormones are able to be transformed back and forth between one another by enzymes in our body. In people with PCOS, there’s an excess of estrogen produced by the ovaries. Some of that estrogen gets turned into androgen.
Why does it cause skin changes?
Because androgen, especially in higher than normal amounts, can cause changes to skin and hair, among other organ systems. People with PCOS also have a higher risk for obesity and insulin resistance. The following are common skin changes seen in people with PCOS:
As many of us know, hormonal acne is a big contributor to the amount of adult acne that’s out there. Androgen is a big offender when it comes to causing acne, because it can lead to excess oil production as well as other changes in the pilosebaceous unit (the lil units of hair and oil glands that inhabit most of our skin). People with PCOS can see hormonal pattern acne which typically affects the chin and jawline, but they can also have acne on other parts of the face and body. Since people with PCOS tend to have irregular menstrual cycles, their breakouts may also be less predictable than those of people with typical hormonal acne.
I’ve written extensively about androgenic alopecia—colloquially known as “male pattern hair loss” before. As a quick refresher: our hair units have receptors for androgen on them. Some people’s receptors are more sensitive than others, and one of the responses our scalp hair has is to miniaturize itself when there is excess androgen is around. However, anyone can develop hair thinning if enough androgen is present. Due to this, androgenic alopecia is a common finding in people with PCOS.
Hair on other parts of the body can have the opposite response to androgen. Hirsutism is the growth of body or facial hair in places where it is usually sparse or absent. While a little bit of facial hair can be normal in XX people, some people with PCOS can develop a full beard as well as new body hair in response to androgen excess. People with curlier hair texture may also develop inflamed and painful ingrown hairs in the beard area – the fancy name for this is pseudofolliculitis barbae. This finding is sometimes mistaken for acne.
Another change commonly seen in people with PCOS is acanthosis nigricans – a velvety dark skin change often seen over the back of the neck, arm pits or other parts of the body. The development of acanthosis nigricans can be a sign of insulin resistance so it is often seen in people who are prediabetic or diabetic. While more of a nuisance than anything else, acanthosis nigricans does underscore the fact that people with PCOS are at a higher risk for developing diabetes.
What can I do about it?
There’s plenty that can be done to help treat PCOS. If you suspect that you might have PCOS, it’s a good idea to talk to your primary care doctor or women’s health specialist. They can help you assess whether this is the correct diagnosis, and if so can also prescribe medications to normalize hormone levels and improve insulin resistance.
As for the dermatologic signs, they can be treated with prescription medications by your dermatologist. Medications like spironolactone help block the effect of androgen on the skin and hair. Another family of medications call 5-alpha reductase inhibitors inhibit the enzyme that converts estrogen to androgen. Hirsutism can be treated with topical eflornithine which helps decrease hair growth, or laser hair reduction. Oral contraceptive pills can also be helpful in addition to traditional medications used for acne, hirsutism and androgenic alopecia.
For more sound dermatologic information, be sure to follow @dermangelo on Instagram.
A special thanks to Carrie Anne for the image above, and for being vocal about her experience living with PCOS.