September 25th, 2024

Understanding Polycystic Ovary Syndrome (PCOS) And The Impact On Skin

Polycystic Ovary Syndrome (PCOS) is a multi-system disease that affects an estimated 5 to 6 million women in the United States with the PCOS Foundation estimating that less than half of women with the condition are actually diagnosed correctly. (1) (2)

The World Health Organization reports that PCOS runs in families, but there are ethnic variations in how PCOS manifests itself and how it affects people. It states further, the prevalence of PCOS is higher among some ethnicities and these groups often experience more complications, in particular related to metabolic problems. (3)

In order to have a diagnosis for PCOS you must undergo testing and the presence of at least two out of three the following must be confirmed:

— polycystic ovaries on an ultrasound scan

— signs or symptoms of high androgens could include Hirsutism (unwanted facial or bodily hair), Alopecia (loss of hair from the head / male pattern baldness), Acne (which is deep set cysts or papules), Acrochordons or Skin Tags (small, soft noncancerous growths made of collagen and blood vessels surrounded by skin), or an elevated blood level of testosterone) – after other causes for this have been excluded

— irregular or absent menstrual periods – after other causes for this have been excluded (3)

Other disorders that mimic the clinical features of PCOS should be excluded: thyroid disease, high prolactin levels, and non-classical congenital adrenal hyperplasia. For example, heavy menstrual bleeding could be caused by a range of conditions, such as uterine fibroids, polyps, bleeding disorders, certain medications, or pelvic inflammatory disease, in addition to PCOS. (4)

Blood tests can be used to identify hormone levels, although not all women will have all of these symptoms.

–Testosterone (an ovarian androgen hormone that influences hair growth)

— Oestrogen (an ovarian hormone that stimulates growth of the womb lining (endometrium)

— Luteinising hormone (LH, a pituitary hormone which influences hormone production by the ovaries and is important for normal ovulation)

— Insulin (a hormone that is principally involved in utilization of energy from food)

— Anti-müllerian hormone (which is measures the fertility level of the ovaries) (3)

PCOS testing could also include a glucose tolerance test as women who are diagnosed with PCOS are more at risk for Type II Diabetes, due to the body displaying insulin resistance.

PCOS & Impact On The Skin (And Hair)

Acanthosis Nigricans- a condition that causes dark, thick, velvety patches of skin that can appear on the neck, underarms, groin, and other areas where the skin folds. It’s insulin resistance that contributes to this

Acrochordons or Skin Tags- small, soft noncancerous growths made of collagen and blood vessels surrounded by skin

Hirsutism- excessive hair growth

Alopecia- also referred to as male patterned baldness

Acne/Oily Skin- acne lesions in those with PCOS are deeper, larger and slower to resolve

The Medical Team & PCOS Treatment

Because this incurable disease is a multi-system disease, most likely a person who is diagnosed with PCOS will have a team to help manage symptoms that will include a primary care physician, an endocrinologist, an obstetrician-gynecologist (OB/GYN), and a dermatologist or aesthetician.

Combined oral contraceptive pills- lowers testosterone in the system, helping to regulate periods, slow down Hirsutism (excess hair growth), slows down the production of sebum (which will lesson the severity of acne),

Sironolactone (yaz)- compliments birth control pills, however not given to men because of side effects. Improves andronetic alopcia as well as lessons acne, and slows hirsutism. This drug is not safe in pregnancy therefore if you are trying to become pregnant, this is not for you.

Yaz contains 3 mg of the progestin DRSP which has antimineralocorticoid activity, including the potential for hyperkalemia in high-risk patients, comparable to a 25 mg dose of spironolactone.

Sometimes, doctors prescribe Yaz off label for PCOS. With off-label use, doctors prescribe a drug for a purpose other than what it’s approved for. The Food and Drug Administration (FDA) approved Yaz for pregnancy prevention. It’s also approved to treat acne and symptoms of premenstrual dysphoric disorder (PMDD).

Another route a medical team may take is retinoids, or Tretinoin however these are not pregnancy safe.

• ClomipheneAn oral anti-estrogen medication that helps induce ovulation. It’s often the first treatment recommended for women with PCOS who are trying to get pregnant. 
• LetrozoleA breast cancer treatment that can stimulate the ovaries. An OBGYN may recommend letrozole over clomiphene if the cause of the issue is PCOS. 
• MetforminA type 2 diabetes medication that can help improve insulin resistance and lower insulin levels. It can also help with weight loss and slow the progression to type 2 diabetes. 
• Birth control pillsContain estrogen and progesterone, which can help regulate menstrual cycles and reduce symptoms of excess androgen production. 
• SpironolactoneAn anti-androgen that can treat PCOS and hormonal acne. It works by blocking androgen receptors and decreasing androgen production from the ovaries and adrenal glands. 
• EflornithineA topical cream that can treat hirsutism. 
• Glucagon-like peptide-1 receptor agonists (GLP-1RAs)Can help with metabolic management of PCOS by causing insulin release and reducing appetite. 

Holistic Treatments Your Aesthetician Can Provide

The Avalon Day Spa has several modalities and suggestions to help alleviate symptoms of PCOS that work with the treatment plans set forth by medical teams.

Deep Sea Hiwa Kai Scrub and Black Baltic Mud Ritual- It may be a long service name, but the benefits are very clear. Acne and oily skin are some of the most common symptoms of those who suffer with PCOS, and this service is designed to unclog pores, remove dead skin, _____.

Signature Bacial with Added High Frequency- A bacial is a facial for your back!

Key Ingredients with Home Care Products- Some of these could include;

Acanthosis Nigricans- Retinol, Dermabrasion and long-pulsed alexandrite laser therapy

Topical medications that have been effective in some cases of acanthosis nigricans include keratolytics (eg, topical tretinoin 0.05%, ammonium lactate 12% cream, or a combination of the 2) and triple-combination depigmenting cream (tretinoin 0.05%, hydroquinone 4%, fluocinolone acetonide 0.01%) nightly with daily sunscreen. ^[27] Calcipotriol, podophyllin, urea, adapalene, and salicylic acid also have been reported, with variable results. ^{[1, 28, 29]}

Oral agents that have shown some benefit include etretinate, ^[30] isotretinoin, ^[31, 32] metformin, ^[33] and dietary fish oils. ^[34] Octreotide showed sustained improvement in one patient with insulin resistance 6 months after completing the course. ^[35]

Research and References

https://www.endocrine.org/patient-engagement/endocrine-library/pcos

https://www.pennmedicine.org/updates/blogs/fertility-blog/2020/march/five-myths-about-pcos

https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome

https://www.princetongyn.com/blog/why-polycystic-ovarian-syndrome-is-often-misdiagnosed