Polycystic ovary syndrome

Published on 18/03/2015 by admin

Filed under Dermatology

Last modified 22/04/2025

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Polycystic ovary syndrome

Rachel V. Reynolds and Terry T. Farsani

Evidence Levels:  A Double-blind study  B Clinical trial ≥ 20 subjects  C Clinical trial < 20 subjects  D Series ≥ 5 subjects  E Anecdotal case reports

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Polycystic ovary syndrome (PCOS) is an endocrinopathy characterized by hyperandrogenism, menstrual irregularities, polycystic ovaries, and metabolic derangement.

Management strategy

Diagnosis is currently based on the Rotterdam 2003 consensus, and must include at least two of the following: (1) oligomenorrhea or amenorrhea; (2) clinical and/or biochemical signs of hyperandrogenism; and (3) polycystic ovaries. It also requires exclusion of other potential etiologies.

Treatment of PCOS is targeted towards decreasing androgen excess, normalizing menses, and ameliorating metabolic syndrome and cardiovascular complications. While treatment of the reproductive and metabolic complications decreases the risk of endometrial cancer and cardiovascular issues, treatment of cutaneous disease is also integral to the care of these patients and their quality of life.

Cutaneous manifestations resulting from androgen excess may include acne in 25–35%, hirsutism in 40–92%, female pattern alopecia, seborrhea, and, in some, acanthosis nigricans, a sign of hyperinsulinemia. Therefore, as dermatologists, we are in a unique position to identify and treat patients early in the course of their disease.

Cutaneous manifestations, including acne and hirsutism, may be targeted using topical or oral retinoids, and/or topical or systemic antibiotics. If the response is inadequate, combined oral contraceptives (OCPs) and/or anti-androgen therapy may be beneficial. Mechanical hair removal methods may be utilized. In patients with PCOS, weight loss may correct all metabolic abnormalities. In those with inadequate response, insulin resistance may be treated with insulin-sensitizing agents, such as metformin.

PCOS is associated with several mental health problems, including depression and anxiety, body dissatisfaction and eating disorders, diminished sexual satisfaction, and lowered health-related quality of life. Patients should be evaluated for psychologic issues and referred for appropriate counseling as needed.

Specific investigations

First-line therapies

image Weight loss A
image Topical and systemic therapy for acne A
image Topical eflornithine B
image IPL/laser hair removal B

Second-line therapies

image Oral contraceptives B
image Anti-androgens B
image Metformin B

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