Hirsutism and Acne in Polycystic Ovary Syndrome

August 2004 in “ Baillière's best practice & research. Clinical obstetrics & gynaecology/Baillière's best practice and research in clinical obstetrics and gynaecology ”

Johanna S. Archer, R. Jeffrey Chang

polycystic ovary syndrome PCOS hyperandrogenism hirsutism acne oral contraceptive pills OCPs antiandrogens spironolactone flutamide finasteride topical medications insulin resistance chronic anovulation birth control pills Propecia

TLDR Lower doses of treatments for hirsutism and acne in PCOS are effective and cause fewer side effects.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age, with a prevalence of 5-10%. It is characterized by symptoms such as hyperandrogenism, chronic anovulation, insulin resistance, and infertility, with hyperandrogenism often presenting as hirsutism and acne. Treatments for these symptoms include oral contraceptive pills (OCPs), antiandrogens like spironolactone, flutamide, and finasteride, and topical medications. Recent studies have indicated that lower doses of these treatments are as effective as higher doses, offering the benefits of reduced costs and fewer side effects. Despite their cosmetic appearance, hirsutism and acne can lead to significant social and emotional distress, and it is important for physicians to address these issues with empathy and care.

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Research cited in this study

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research Metformin or Antiandrogen in the Treatment of Hirsutism in Polycystic Ovary Syndrome

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Metformin is effective for treating excessive hair growth in women with PCOS and may work better than the standard treatment in some ways.

research The Evaluation and Management of Hirsutism

195 citations, May 2003 in “Obstetrics and gynecology (New York. 1953. Online)/Obstetrics and gynecology”

Most women with excess hair growth have an underlying hormonal issue, often treated with medication and hair removal methods.

research Update and Future of Hormonal Therapy in Acne

78 citations, January 2003 in “Dermatology”

Hormonal therapy is becoming a promising treatment for acne.

research Comparison of High-Dose Finasteride (5 mg/day) Versus Low-Dose Finasteride (2.5 mg/day) in the Treatment of Hirsutism

51 citations, October 2002 in “European journal of endocrinology”

Low-dose finasteride effectively treats hirsutism, is safe, and cost-effective.

research The Effect of Metformin on Hirsutism in Polycystic Ovary Syndrome

90 citations, August 2002 in “European journal of endocrinology”

Metformin improves hair growth and menstrual frequency in women with PCOS and hirsutism.

research The Effect of Two Combined Oral Contraceptives Containing Either Drospirenone or Cyproterone Acetate on Acne and Seborrhea

74 citations, April 2002 in “PubMed”

Both oral contraceptives reduced acne effectively and had similar positive effects on skin oiliness and hair growth.

research Management of Unwanted Hair in Females

27 citations, December 2001 in “Clinical and experimental dermatology”

Different hair removal methods have pros and cons, and more evidence is needed to prove laser treatments work.

research Vaniqa: Eflornithine 13.9% Cream

34 citations, April 2001 in “PubMed”

Vaniqa cream slows unwanted facial hair growth in women.

research Topical Eflornithine: Efficacy in Reducing Unwanted Facial Hair Growth in Women

115 citations, January 2001 in “American journal of clinical dermatology”

Eflornithine cream effectively reduces women's unwanted facial hair but hair returns if treatment stops.

research A Prospective, Randomized Trial Comparing Flutamide (250 mg/d) and Finasteride (5 mg/d) in the Treatment of Hirsutism

50 citations, May 2000 in “Fertility and Sterility”

Flutamide reduces hair growth better but has more side effects.

research Comparison of Spironolactone, Flutamide, and Finasteride Efficacy in the Treatment of Hirsutism: A Randomized, Double-Blind, Placebo-Controlled Trial

46 citations, January 2000 in “The Journal of Clinical Endocrinology and Metabolism”

research Electrolysis: Observations from 13 Years and 140,000 Hours of Experience

132 citations, October 1995 in “Journal of the American Academy of Dermatology”

Electrolysis is effective for permanent hair removal, but technique is key to avoid scarring, and sometimes hormonal treatment is needed for women with hirsutism.

research A Prospective Randomized Trial Comparing Finasteride to Spironolactone in the Treatment of Hirsute Women

34 citations, January 1995 in “The Journal of Clinical Endocrinology and Metabolism”

research Comparison of Flutamide and Spironolactone in the Treatment of Hirsutism: A Randomized Controlled Trial

165 citations, February 1994 in “Fertility and Sterility”

Flutamide is more effective and has fewer side effects than spironolactone for treating hirsutism.

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research Prevalence of Androgenic Alopecia in Patients with Polycystic Ovary Syndrome and Characterization of Associated Clinical and Biochemical Features

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Women with PCOS often have hair loss, which is linked to acne or excess body hair but not to worse hormone or metabolic issues.

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Diagnosing and treating PCOS is complex due to differing criteria and requires a team approach.

research Evidence-Based Approach to Cutaneous Hyperandrogenism in Women

42 citations, July 2015 in “Journal of The American Academy of Dermatology”

The conclusion is that oral contraceptives and antiandrogens can treat hirsutism and acne in women with cutaneous hyperandrogenism, but more research is needed for effective treatments, especially for hair loss.