PCOS and The Skin
Dr Raelia Lew speaks with Dr Alice Rudd, Dermatologist about how PCOS impacts skin condition and effective treatment options.
PCOS which stands for Polycystic Ovarian Syndrome is a very real disorder affecting one in twelve reproductive-aged women. PCOS can have many effects on the skin including hair concerns and acne. There are many different care modalities that can be used to support those suffering with PCOS. However some skin treatment options are not safe for women who are trying to have a baby, leaving many sufferers anxious about the outcome for their skin. Join Dr Raelia Lew (Reproductive Endocrinologist and Fertility Specialist) and Dr Alice Rudd (Dermatologist) to learn more about PCOS and how sufferers can care for their skin during pregnancy planning.
Dr Lew, what exactly is Polycystic Ovarian Syndrome (PCOS)?
Polycystic Ovarian Syndrome (PCOS) is a complicated condition that affects a woman in many domains. It can involve ovarian hormone imbalance, where high levels of androgens (male hormones) are produced in the context of a powerful, high ovarian reserve. Insulin resistance also sometimes plays a role in this syndrome. Carrying excess body fat can exacerbate symptoms of the syndrome and having PCOS in turn makes it metabolically harder for a woman to maintain or reduce her weight.
Dr Lew, what are some special concerns for women trying to conceive with PCOS?
Women with PCOS are often (pleasantly) surprised at how readily they are able to conceive with my help. My focus is in regulating their cycle, achieving predictable, regular ovulation (release of an egg) each month. We focus holistically on a variety of care elements including lifestyle focussed therapy, metabolism regulation therapy, diet, exercise targeted change and where needed, ovulation induction with ultrasound monitoring. Many women with PCOS are inaccurately advised they have failed ovulation induction because they have not ovulated using simple methods like clomiphene citrate. As a CREI accredited reproductive endocrinologist and fertility specialist, I am fully trained in more complex methods of ovulation induction. This means that I am able to help the vast majority of my patients with PCOS to conceive safely and naturally.
However, aside from concerns about infertility, women with PCOS who plan to conceive also face fears of embarrassing acne breakout, body and facial hair excessive growth and scalp hair loss returning when they cease their regular PCOS control regimen in order to conceive.
Dr Lew, how can I keep my symptoms in control and prepare for pregnancy?
Women with PCOS need professional support. At Women’s Health Melbourne, we communicate and collaborate as a holistic team. Your medical management team may consist of:
Your GP
Your Reproductive Endocrinologist/CREI Fertility Subspecialist
Your Dermatologist
Your Endocrinologist
Your fitness guru or exercise physiologist
Your mind-body support professional
Your Nutritionist
Your lifestyle coach or naturopath
Dr Rudd, can you provide some more insight into the skin concerns PCOS sufferers present with?
PCOS may have a range of skin manifestations, from none at all to multiple and severe. The most common skin issue is acne. Acne is often located around the chin and cheek area and commonly worsens with the menstrual cycle. Hirsuitism or excessive hair growth affecting the face or body is another common unwanted effect. Hair thinning on the crown and at the hairline in a male baldness pattern (androgenetic alopecia) is also common and can be distressing and debilitating for many women. Other rarer issues such as boils in the groin and armpits, and also rashes related to excessive weight and hormonal imbalances may also be seen.
Treatments of the skin can vary. For mild acne and hair growth, simple measures such an optimised skin care routine, skin treatments, and hair removal techniques such as laser can be used. For more severe symptoms, medication may be needed. This could be as simple as certain skin directed oral contraceptive pills, up to low dose vitamin A medications.
Dr Rudd, during conception, some treatments for PCOS sufferers are contraindicated. What is safe to continue?
Many of the oral medications used to assist PCOS sufferers have to be stopped during the preconception phase. These medications are not appropriate or safe in the lead up to or during pregnancy. However PCOS sufferers should know there are many things we can still do to help.
Our recommendations include in-clinic treatments, skincare or a combination of both. The type and severity of the acne will determine the treatment solution. Treatments that work best include extractions and light therapies such as LED or Kleresca and chemical peels. These treatments are non-invasive and are completely safe during the conception phase. In many cases, treatments are also safe during pregnancy (your Dermatologist or Dermal Clinician can advise you).
If you are abnormal or excessive hair growth has returned and is concerning you, laser or IPL hair reduction technologies are considered safe during this time. Therapy can be administered on the face or body including sensitive areas. The stomach and pelvic area need to be avoided once conception is successful.
Once pregnant what skin products and treatments can be safely used throughout pregnancy?
Niacinamide (a vitamin B derivative) is a completely safe topical form of skincare that helps balances hydration and manage oil production for acne prone skin. It helps to combat nasty bacteria, working similarly to a topical antibiotic and can also improve inflammation. Benzac is another recommendation which can be a good option for pregnant ladies looking for a safe spot treatment for pustular acne. A skin care routine directed to the individual’s type of acne can be suggested. Certain prescription medications can be safely used during the conception and pregnancy phases. These should only be used on medical advice from your dermatologist. Injectable cortisone can also be beneficial in large acne cysts that sometimes can arise during pregnancy.
Hair removal techniques such as dermablading are safe during pregnancy.
It is also very important to address diet, reducing dairy and sugar levels. Good nutrition during pregnancy is critical. We advise seeking personalised advice from your specialist or clinical nutritionist.
In-clinic treatments including LED Healite, extractions and fruit-extract peels are excellent options. These treatments may be regularly used to rejuvenate healthy skins cells and reduce ongoing inflammation that can occur with acne.
Reviewed by Dr Raelia Lew
RANZCOG Board Certified CREI Fertility specialist, Gynaecologist and the Director of Women’s Health Melbourne.
Co-host of the Knocked Up Podcast, Co-founder of Ellechemy intimate wellness solutions. Raelia has a PhD in Preconception Health Promotion and Genetic Screening. Raelia is a leading Australian expert in IVF and egg freezing, pioneering a bespoke model of care.