The great impact of polycystic ovary syndrome on skin
Have you ever heard about polycystic ovary syndrome? Mostly known as PCOS, it is a syndrome, which means that multiple signs and symptoms occur together to define a health condition. This is considered the most common female endocrine disorder: the incidence is estimated to be from 4% to 20% worldwide among women of reproductive age . Family history is considered a risk factor .
Some of the causes are still unclear, but for sure the hormonal imbalance plays a big role. Ovaries, in fact, produce testosterone in excess: this condition is known as hyperandrogenism. Remember that testosterone is not exclusively a male hormone: even if in different amount, women produce testosterone as well (and it is fundamental!). In PCOS, the testosterone levels are just too high. Of course, this hormonal alteration has important consequences: the ovulation process can be dysregulated, with the result that usually women suffering from PCOS have dysmenorrhea (menstrual irregularities) and sometimes painful periods. From a morphological point of view, small cysts on ovaries may be observed. All these sexual hormones imbalance can reduce the fertility, and this is one of the reasons why this disease should not be underestimated.
Moreover, there are often other symptoms defining this syndrome: one of the most important is the insulin resistance, where cells do not respond properly to insulin, leading in some cases to type II diabetes .
What about the skin?
There are many visible signs to consider for PCOS. Due to the high testosterone levels, it is possible that women manifest hirsutism, an excess of body hair, also in non-common areas of the body and on the face (chin, trunk, chest).
On the other side, a major hair loss or thinner hair on the scalp is common. It can end up with androgenic alopecia.
Acne is another psychological issue: usually it appears in the lower part of the face(jawline, upper neck) with more extended breakouts and lesions, painful and more difficult to resolve. This is so because androgens increase sebum and oil production in skin, thus increasing acne formation.
A typical skin condition that could appear as well is acanthosis nigricans, where usually some dark velvety spots develop around the neck and underarms [4, 5].
How to treat polycystic ovary syndrome?
Even though there is no real cure for PCOS, several treatments are suggested, mostly for managing the symptoms. Maintaining a correct weight is crucial, also for the insulin resistance problem: for this reason, a healthy and varied diet, including fruits and vegetables, is recommended.
On the other side, it is better to avoid food and beverages rich in sugars and carbohydrates that could exacerbate insulin resistance.
Daily exercise is strongly suggested: it can ease the symptoms and reduce insulin resistance, and, if combined with a good diet, can improve ovulation .
For acne, contraceptive pills are the most common option, but also spironolactone (a drug that blocks testosterone conversion in DHT, major responsible for hirsutism and hair loss) can be used, with good results.
Hirsutism usually is treated with laser hair removal or electrolysis, but it is important to consult an endocrinologist and other specialist in advance and do some exams: these treatments could be useless if the hormonal imbalance is too enhanced. In some cases, a topical treatment such as Eflornithine cream that acts directly in the hair follicle inhibiting the new growth of the hair is used.
For diabetes or insulin resistance, metformin (oral antidiabetic drug) may be prescribed [6,7].
All these treatments are prescription drugs: for this reason, it is necessary to have a diagnosis properly done by experts who can create a tailored approach for each patient.
Interesting studies have been investigating the role of certain food supplements (inositol, antioxidants, folic acid…) but so far, evidence is low and new trials are needed [8,9].
A multi-specialist approach in polycystic ovary syndrome
Being a complex syndrome means that many specialists need to be involved in diagnosing and evaluating polycystic ovary syndrome. The primary care physician, together with endocrinologists, gynecologists and dermatologists must work together.
Last but not least, PCOS can cause a big distress affecting women’s mental health, and the psychological aspect must not be forgotten. A psychologist or therapist can be a great help .
Girls, women: if you suffer from PCOS don’t feel ashamed: you are not alone.
If you want, share with us your experiences!
 Deswal, R., Narwal, V., Dang, A., & Pundir, C. S. (2020). The Prevalence of Polycystic Ovary Syndrome: A Brief Systematic Review. Journal of Human Reproductive Sciences, 13(4), 261–271. https://doi.org/10.4103/jhrs.JHRS_95_18
 Kahsar-Miller, M., & Azziz, R. (1998). The development of the polycystic ovary syndrome: Family history as a risk factor. Trends in Endocrinology and Metabolism. https://doi.org/10.1016/S1043-2760(98)00021-6
 Lim, Siew S., Hutchison, S. K., Van Ryswyk, E., Norman, R. J., Teede, H. J., & Moran, L. J. (2019). Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD007506.pub4
 Brutocao, C., Zaiem, F., Alsawas, M., Morrow, A. S., Murad, M. H., & Javed, A. (2018). Psychiatric disorders in women with polycystic ovary syndrome: a systematic review and meta-analysis. Endocrine. https://doi.org/10.1007/s12020-018-1692-3
 De Moura, H. H. G., Costa, D. L. M., Bagatin, E., Sodré, C. T., & Manela-Azulay, M. (2011). Polycystic ovary syndrome: A dermatologic approach. An. Bras. Dermatol. https://doi.org/10.1590/S0365-0596201100010001
 Bednarska, S., & Siejka, A. (2017). The pathogenesis and treatment of polycystic ovary syndrome: What’s new? Advances in Clinical and Experimental Medicine. https://doi.org/10.17219/acem/59380
 Meier RK. Polycystic Ovary Syndrome. Nurs Clin North Am. 2018 Sep;53(3):407-420. doi: 10.1016/j.cnur.2018.04.008. Epub 2018 Jul 11. PMID: 30100006.
 Arentz, S., Smith, C. A., Abbott, J., & Bensoussan, A. (2017). Nutritional supplements and herbal medicines for women with polycystic ovary syndrome; a systematic review and meta-analysis. BMC Complementary and Alternative Medicine. https://doi.org/10.1186/s12906-017-2011-x
 Showell, M. G., Mackenzie-Proctor, R., Jordan, V., Hodgson, R., & Farquhar, C. (2018). Inositol for subfertile women with polycystic ovary syndrome. The Cochrane database of systematic reviews, 12(12), CD012378. https://doi.org/10.1002/14651858.CD012378.pub2
Sitography -Harvard Health Publishing
-Hopkins medicine: https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos
-Post acne scars: a big problem with a feasible solution https://www.emotion- vbg,..mmaster-studentproject.eu/post/acne-scars-a-big-problem-with-a-feasible-solution
Other interesting reviews:
Lim, S. S., Kakoly, N. S., Tan, J. W. J., Fitzgerald, G., Bahri Khomami, M., Joham, A. E., … Moran, L. J. (2019). Metabolic syndrome in polycystic ovary syndrome: a systematic review, meta-analysis and meta-regression. Obesity Reviews. https://doi.org/10.1111/obr.12762
Main picture: Virna Lisi photographed from Jean-Paul Goude, cover of Esquire 1965.