From the Guidelines
From a dermatologist's perspective, PCOS treatment focuses on managing skin manifestations like acne, hirsutism, and hair loss, with first-line treatments including combined oral contraceptives containing ethinyl estradiol with anti-androgenic progestins like drospirenone or cyproterone acetate, typically used for 6-12 months, as recommended by the most recent evidence 1.
Treatment Options
- Combined oral contraceptives: containing ethinyl estradiol with anti-androgenic progestins like drospirenone or cyproterone acetate, used for 6-12 months, as supported by a Cochrane review 1
- Spironolactone (50-200 mg daily): effective for both acne and hirsutism, though requires monitoring for hyperkalemia and is contraindicated in pregnancy
- Topical treatments for acne: retinoids (adapalene, tretinoin), benzoyl peroxide, and antibiotics (clindamycin)
- Oral antibiotics for moderate-to-severe acne: doxycycline (100 mg daily)
- Hirsutism management: temporary hair removal methods (shaving, waxing) or permanent options like laser hair removal and electrolysis
- Female pattern hair loss treatment: topical minoxidil 5% applied twice daily
Lifestyle Management
- Multicomponent lifestyle intervention, including diet, exercise, and behavioral strategies, is central to PCOS management, with a focus on weight and healthy lifestyle behaviors, as recommended by the international evidence-based guideline for the assessment and management of PCOS 1
- No specific diet is recommended, but a healthy lifestyle is encouraged
Multidisciplinary Approach
- A multidisciplinary approach involving dermatologists, gynecologists, and endocrinologists typically yields the best results for PCOS patients, as it addresses the complex hormonal imbalance and various symptoms of PCOS, including skin manifestations, reproductive issues, and metabolic concerns 1
From the Research
Treatment Options for PCOS from a Dermatologist's Perspective
The treatment of Polycystic Ovary Syndrome (PCOS) from a dermatologist's perspective involves managing the cutaneous manifestations of the condition, such as acne, hirsutism, and androgenetic alopecia.
- The management of PCOS should be tailored to each woman's specific goals, reproductive interests, and particular constellation of symptoms, and a multidisciplinary approach is recommended 2.
- Therapies discussed for the treatment of PCOS include lifestyle modification, topical therapies, combined oral contraceptives, antiandrogen agents, and insulin-sensitizing drugs 2.
- For women with PCOS who do not desire pregnancy, common therapies include oral contraceptive pills, antiandrogens, and insulin-lowering treatments 3.
Dermatological Manifestations of PCOS
The common dermatological manifestations of PCOS include:
- Hirsutism
- Acne
- Alopecia
- Acanthosis nigricans These manifestations should be evaluated and managed by a dermatologist as part of a multidisciplinary team approach 4.
Importance of Multidisciplinary Approach
A multidisciplinary team approach involving a reproductive endocrinologist, dermatologist, psychologist/psychiatrist, dietician, and sometimes a bariatric surgeon is necessary for the long-term management of PCOS 4.
- Unless metabolic and underlying endocrinal disturbances are corrected and simultaneous lifestyle modification is adopted, cosmetic treatment would give only temporary relief 4.
Role of Dermatologists in PCOS Management
Dermatologists play a key role in the diagnosis and management of PCOS, as they frequently evaluate and manage the cutaneous manifestations of the condition 5.
- The diagnosis of PCOS involves the evaluation of hyperandrogenism, hyperinsulinemia, and other associated hormonal pathways that culminate in metabolic, reproductive, and cardiovascular effects 5.