From the Guidelines
Yes, sebum production in PCOS can worsen seb derm, and managing hormonal imbalances with treatments like oral contraceptives can help reduce sebum production and improve symptoms. Women with polycystic ovary syndrome (PCOS) often experience increased androgen levels, which stimulate sebaceous glands to produce more sebum 1. This excess oil production creates an environment that favors the growth of Malassezia yeast, a key contributor to seborrheic dermatitis.
Key Points to Consider
- The use of combined oral contraceptives (COCs) containing estrogen and progestin can address the hormonal pathogenesis of acne, decreasing free testosterone by 40‑50% on average, and reducing sebum production 1.
- A course of three to six months of therapy is typically required for patients to experience the full benefit of treatment with a COC 1.
- Progestin only contraceptives and long‑acting reversible contraceptives are associated with worsening of acne, and potentially seborrheic dermatitis 1.
Management Strategies
- Managing PCOS through treatments that address hormonal imbalances—such as oral contraceptives—may help reduce sebum production and consequently improve seborrheic dermatitis symptoms.
- Using antifungal treatments like ketoconazole shampoo, selenium sulfide, or zinc pyrithione products can directly target the yeast component.
- Gentle cleansing to remove excess oils without irritating the skin and avoiding triggers like stress and certain skincare products containing alcohols or fragrances may also help manage both conditions simultaneously.
From the Research
Sebum Production in PCOS and Seb Derm
- Sebum production is a key factor in the development of seborrheic dermatitis (SD), and patients with polycystic ovary syndrome (PCOS) often experience increased sebum production due to hyperandrogenism 2.
- However, there is no direct evidence to suggest that sebum production in PCOS worsens seborrheic dermatitis.
- Treatment for seborrheic dermatitis typically involves topical antifungal and anti-inflammatory agents, and systemic therapy is reserved for widespread lesions or cases that are refractory to topical treatment 3, 4, 5.
- In PCOS patients, treatment with metformin and anti-androgens such as spironolactone can help reduce clinical and biochemical hyperandrogenism, which may in turn affect sebum production 6.
- Further research is needed to fully understand the relationship between sebum production in PCOS and seborrheic dermatitis.
Treatment Options for Seborrheic Dermatitis
- Topical antifungal agents such as ketoconazole are commonly used to treat seborrheic dermatitis 3, 5.
- Anti-inflammatory agents such as topical corticosteroids and calcineurin inhibitors can also be used, but should be used for short durations due to possible adverse effects 5.
- Systemic therapy with oral antifungals such as itraconazole and terbinafine can be used in severe or unresponsive cases 3, 4.