PCOS — My Skin & Me

September is the PCOS (Polycystic Ovarian Syndrome) awareness month, so I’d like to wave goodbye to September by shedding some further light on the syndrome and sharing with our readers some information that might help ladies reach an early diagnosis as well as some skin related management tips for this difficult multisystem disease. It’s a grim fact that worldwide PCOS affects 6% to 10% of women, making it the most common endocrinopathy in women of childbearing age. 

Early diagnosis and establishing a good management plan are key to managing cosmetic issues and preventing long term health consequences, as there is no cure for PCOS.

PCOS At A Glance

Common symptoms of PCOS include irregular or no menstrual periods, acne, obesity/weight gain/inability to lose weight, breathing problems while sleeping, depression, oily skin/acne, infertility, skin discolorations, high cholesterol levels, elevated blood pressure, excessive/abnormal hair growth and distribution, pain in the lower abdomen and pelvis, multiple ovarian cysts, and skin tags. Some women have only a few symptoms, while others have several.

How Do You Know If You Have PCOS?

You can be diagnosed with PCOS if you have at least 2 of the following 3 criteria

1. Irregular or absent periods,

2. Blood tests or physical signs that show high androgens,

3. Polycystic ovaries.

Health Risks With PCOS

Women with PCOS have greater chances of developing several serious health conditions, including life-threatening diseases. Recent studies found that:

·      More than 50 percent of women with PCOS will have diabetes or pre-diabetes (impaired glucose tolerance) before the age of 40.

·      The risk of heart attack is 4 to 7 times higher in women with PCOS than women of the same age without PCOS.

·      Women with PCOS are at greater risk of having high blood pressure.

·      Women with PCOS have high levels of LDL (bad) cholesterol and low levels of HDL (good) cholesterol.

·      Women with PCOS can develop sleep apnea. This is when breathing stops for short periods of time during sleep.

·      Women with PCOS may also develop anxiety and depression. It is important to talk to your doctor about treatment for these mental health conditions.

·      Women with PCOS are also at risk for endometrial cancer. Irregular menstrual periods and the lack of ovulation cause women to produce the hormone estrogen, but not the hormone progesterone. Progesterone causes the endometrium (lining of the womb) to shed each month as a menstrual period. Without progesterone, the endometrium becomes thick, which can cause heavy or irregular bleeding. Over time, this can lead to endometrial hyperplasia, when the lining grows too much, and cancer.

Skin & PCOS

Being a dermatologist I’d like to focus on the skin-related symptoms of PCOS, which include oily skin, adult acne, increased/abnormal hair growth, skin tags, and dark velvety skin patches on neck known as acanthosis nigricans.

Acne and oily skin:

One of the earliest signs of PCOS is acne and oily skin which are primarily the result of hormonal disorders caused by androgens (male hormones). PCOS-related acne tends to flare in areas that are usually considered “hormonally sensitive,” especially the lower third of the face. This includes your cheeks, jawline, chin, and upper neck. Ladies with PCOS tend to get acne that involves more tender knots under the skin, rather than fine surface bumps, and these acne lesions tend to flare before the menstrual period. This type of cystic acne doesn’t resolve quickly and takes time to go away.

Unwanted Hair Growth:

Unwanted hair growth is also triggered by an excess of male hormones leading to excessive growth of facial hair, as well as hair on the abdomen and around the nipples. The same hormones are also responsible for hair loss on scalp, which is why ladies suffering with PCOS struggle with thinning hair on scalp and increased hair on face and body at the same time. Shaving, waxing, depilatories, and tweezing are all options, but each has its limitations and each demands ongoing efforts. Vaniqa cream has shown promising results to reduce facial hair growth. Laser hair reduction is another good long-term option.

Medications called anti-androgens may reduce hair growth and clear acne. Spironolactone (Aldactone), first used to treat high blood pressure, has been shown to reduce the impact of male hormones on hair growth in women. Finasteride (Propecia), a medicine taken by men for hair loss, has the same effect. Anti-androgens are often combined with birth control pills.  These medications should not be taken if you are trying to become pregnant.

Metformin (Glucophage) reduces insulin levels, and this change, in turn, reduces the ovarian testosterone levels by competitive inhibition of the ovarian insulin receptors. This drug is effective in treating increased hair in women with PCOS.

Hair Loss:

The type of hair loss women with PCOS experience is directly related to the excess production of male hormones caused by the disorder. Referred to as male-pattern baldness, it can be successfully treated with over-the-counter medications containing Minoxidil or Saw Palmetto along with oral contraceptive pills (Diane 35) and anti-androgen (Spironolactone) medication.

Skin Darkening:

The brown skin discolorations that occur with PCOS are unique, and are called “Acanthosis Nigricans”. They appear as darkened, velvety swaths of dark brown patches that most often develop on the nape of neck, armpits, inner thighs, or under the breast areas. Although these discolorations are not related to sun damage, the treatment is the same: daily exfoliation, sunscreen, and use of a topical over-the-counter skin-care product with 2% hydroquinone or other skin lightening agents. For stubborn cases, you may need a prescription-strength skin lightener that contains 4% hydroquinone.

Skin Tags:

Fleshy skin growths in the armpits and neck regions are commonly spotted in PCOD. Once the hormones are fixed we can surgical remove or cauterize these growths.

Management Plan

Lifestyle modifications are considered first-line treatment for women with PCOS. Such changes include the following:

·      Diet - Low-fat, high-carbohydrate diets may increase insulin levels, so you may want to consider a low-carbohydrate diet if you have PCOS. Don't severely restrict carbohydrates; instead, choose complex carbohydrates, which are high in fiber. The more fiber in a food, the more slowly it's digested and the more slowly your blood sugar levels rise. High-fiber carbohydrates include whole-grain breads and cereals, whole-wheat pasta, bulgur wheat, barley, brown rice, and beans. Limit less healthy, simple carbohydrates such as soda, excess fruit juice, cake, candy, ice cream, pies, cookies and doughnuts.

·      Exercise - Exercise helps lower blood sugar levels. If you have PCOS, increasing your daily activity and participating in a regular exercise program may treat or even prevent insulin resistance and help you keep your weight under control.

·      Weight loss - Obesity makes insulin resistance worse. Weight loss can reduce both insulin and androgen levels and may restore ovulation. No single specific dietary approach is best, but losing weight by reducing how many calories you consume each day may help with polycystic ovary syndrome, especially if you're overweight or obese. Use smaller plates, reduce portion sizes and resist the urge for seconds to help with weight loss. Ask your doctor to recommend a weight-control program, and meet regularly with a dietitian for help in reaching weight-loss goals.

Medications used in the management of PCOS include the following:

·      Oral contraceptive agents (eg, ethinyl estradiol, medroxyprogesterone)

·      Antiandrogens (eg, spironolactone, leuprolide, finasteride)

·      Hypoglycemic agents (eg, metformin, insulin)

·      Selective estrogen receptor modulators (eg, clomiphene citrate)

·      Topical hair-removal agents (eg, eflornithine)

·      Topical acne agents (eg, benzoyl peroxide, tretinoin topical cream (0.02–0.1%)/gel (0.01–0.1%)/solution (0.05%), adapalene topical cream (0.1%)/gel (0.1%, 0.3%)/solution (0.1%), erythromycin topical 2%, clindamycin topical 1%, sodium sulfacetamide topical 10%)

The optimal management for PCOS is a multi-factorial approach involving diet and lifestyle modification along with appropriate medication. If you think that you have any symptoms which point towards PCOS speak to your GP as soon as possible.

Celebrity Beauty “Secrets” — Good Genes Or Great Skincare

I kept being asked, “How do the celebs look so flawless day in and day out?” my answer is simple and realistic it takes a village to perfect a red carpet look. Most celebs work with a team of people dedicated to helping them look flawless — aestheticians, dermatologists, makeup artists, and photographers. I speak from professional experience when I say that the stars are just like everyone else: They experience dark circles, cystic acne, blackheads, and brown spots. But, since their physical appearance is an important and integral part of their careers, they spend a lot of time and money doing whatever they need to put their best face forward.

Myth Busted: “Celebs have Good Genes”

While good genes definitely play a role in certain skin conditions like oiliness, skin color, and skin thickness, you might be surprised to learn that approximately 30% of aging can be attributed to genetics and 70% to personal habits. This fact is clinically proven by studies that evaluated how identical-twins age. If it were all left to genetics, it would make sense for twins to age in the same manner and at the same rate, but research has shown us that lifestyle factors play a huge role. For example, if one person smokes or works in a profession that forces them to have more exposure to UV rays, one is bound to age faster than the other non-smoking twin who is rarely exposed to harmful UV rays. 

Most skin experts agree on the fact that good genes definitely play a role in how skin looks and acts, but, ultimately, it's how you take care of your skin on a daily basis that's a reflection of your age.

Real “Secrets” Of Celeb Skincare

Celebs do have a few tricks up their sleeves, which help them keep their skin flawless. Here’re a few cardinals rules that you can adopt to give your self an edge on the rest of the nescient populace.

Understand Your Skin Type And Stay Loyal To Your Skincare Routine

The first and most important rule to achieve good skin is: understanding your skin type — normal, dry, oily, pigmented, sensitive or a mix. Second rule to be on your way to achieve skin perfection is: using products created for your specific skin type only. If people with oily skin will use products for dry skin only a disaster and an acne flare can come out of that. If you are unable to match your correct skin type to your skincare routine get professional help and see a dermatologist. Once you find the winning formula stick to it don’t change for the heck of changing. If your skin is changing, then and only then is it time for a change. In your daily skincare routine look for products with active ingredients like retinol, vitamin C, peptides, and salicylic acid, find a well-formulated moisturizer with sunscreen and apply it generously to the face and neck 365 days a year. Sunscreen is absolutely the most effective anti-aging product available.

Professional Skincare Treatments

Chemical peels, oxygen treatments, bio-brasion, ultrasonic exfoliation, Mesotherapy, LED light, micro-current, RF facials Ultrasound facials…they do it all, oftentimes on a weekly basis. Of course, for a lot of us, this isn't realistic — or affordable — but good skin maintenance is something we can all manage. And, if you can't make it into a med spa or dermatologist’s office for monthly treatments, look for at-home treatments that can boost your skin similarly.

Stay Out Of Sun

Number one cause of wrinkles and skin pigmentations is UV rays from the sun, wearing an SPF moisturizer on the face and neck, 365 days a year, rain or shine, inside or outside is imperative. And, whenever possible (and assuming you’re interested in avoiding premature wrinkles), limit your time in the sun. Your skin will thank you and you’ll keep a smooth, healthy-looking, and even-toned texture.

Don’t be a starry-eyed fool next time you see a celebrity in a magazine. Their beauty routine is likely anything but easy and effortless.