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PCOS & Skin | Dermatologist Review
 
PCOS is a multisystem disorder seen in women.  Up to 20% of the population will suffer from PCOS.  PCOS is essentially a metabolic syndrome, however, the first presentations are often in the skin.
 
2.  How do we diagnose PCOS?
Essentially, two out of three characteristic findings would a patient with PCOS.
1.  Irregular menses.
2.  Ultrasound scan which shows multiple cysts in the ovaries.
3.  Signs or symptoms of elevated androgen levels
 
3.  What are the skin signs of PCOS?
Patients may present with some if not all of the following features.  Acne which is usually located around the jawline area.  Unlike normal acne, PCOS acne is often hormonally based with deep-seated lesions and the relative paucity of blackheads.  Characteristically, acne flares during the period cycle and patients present with painful cysts.  Scarring from this type of acne is not infrequent due to the fact that patients often pick at the lesions.
 
Another manifestation of PCOS is oily skin also known as seborrhoea.  This may be isolated or can occur with acne.

Hirsutism or excess hair is frequent seen in PCOS. Treatment is with laser hair removal.
Unlike normal hair growth, patients with PCOS will often need 1-2 'Maintenance treatments
every 12-18 months.

Hair loss is another complaint with the patients who have PCOS.  Hair loss is also known as androgenetic alopecia and infects the scalp.  Conversely, there may be excessive hair in other areas such as the face and chest/back.  This is known as hirsutism.
 
Other skin changes include acne inversa also known as hidradenitis suppurativa.  This can present as lumps and bumps together with painful sinuses located under the arms, in the groin area and often under the breast area. Medical management can alleviate symptoms of HS.
 
Darkening of the skin can occur in PCOS patients.  This condition is called acanthosis nigricans.  Additionally, skin tags may form around the armpits, under the breast area or in the groin area. An endocrinologist or a medical dermatologist can assist with treatment of AN. Metformin and low strength topical retinoid can help.
 
PCOS should be managed as a multi-team approach.  The best speciality to address all these features would be an endocrinologist with input from a medical dermatologist and OBG.  There are many ways to treat this condition which goes beyond the scope of this presentation.  Dermatologists can also manage both hirsutism, hair loss and also acne.  As this is a metabolic disease, close monitoring of patient's vitals including blood pressure, cholesterol, weight and other factors is paramount.

Thanks for viewing this video. One new video every weekend.

Dr Davin S. Lim
Procedural Dermatologist
Cutis International
Brisbane. Australia.