Polycystic Ovarian Syndrome
- Ms M most likely has polycystic ovarian syndrome (PCOS)
- Affected individuals must have two out of the following three criteria: (1) oligo- and/or anovulation, (2) hyperandrogenism (clinical and/or biochemical), and (3) polycystic ovaries on sonographic examination*
- In addition to hormonal acne, increased circulating androgens also results in hirsutism
- Women with PCOS also have a greater degree with insulin resistance which can cause acanthosis nigricans
Androgens in Acne
In many post adolescent women, antiandrogen therapy can improve acne
- These women have hormonal acne; their serum hormone levels are usually normal
- Hormonal acne lesions are often perioral and along the jaw line
- Many women report a pre-menstrual flare
Not all women with hormonal acne are tested for hyperandrogenism
- However, it should be considered in the female patient whose acne is severe, sudden in onset, or associated with hirsutism or irregular menses
More Examples of Hormonal Acne
Inflammatory acne on the lateral and inferior face, especially along the jawline
Treatment of Hormonal Acne
- Commonly used agents to treat hormonal acne include:
- Spironolactone 50mg -100mg daily
- Oral contraceptives
- The following oral contraceptives have been approved by the FDA for treatment of acne: Yaz, Ortho Tri-cyclen, Estrostep
- There is good evidence and consensus opinion that other estrogen-containing OCPs are also effective