Cosmetic Concerns

What causes acne and what can be done to reduce it?

Acne can be caused by increased androgen levels. The androgens increase sebum a combination of skin oils and old skin tissue and the sebum plugs skin pores allowing bacteria to thrive and cause inflammation.

Anti-androgen medications such as spironolactone (Aldactone), Flutamide, cyproterone acetate, and Finasteride can help reduce acne, as can oral contraceptives. These medications cannot be used while trying to conceive. Accutane (isotretinoin), a prescription medication used to treat severe nodular acne that has not responded to other therapies, is also contraindicated in pregnancy or while trying to conceive as it is known to cause fetal deformities. Insulin-sensitizing medications may reduce acne by restoring hormone balance. Some over-the-counter medications may also reduce outbreaks.

What causes darkened skin patches (acanthosis nigricans) and what can be done to lighten them?

The exact cause is not known, but acanthosis nigricans is often seen in association with endocrine disorders such as insulin resistance and PCOS. This is a darkening of the skin ranging from tan to dark brown/black that commonly appears on the back of the neck, armpits, under breasts, in the groin area, and sometimes on the elbows, knees and hands. The skin is usually velvety or rough to the touch. It may look as if it is dirty and could be scrubbed off. Acanthosis nigricans cannot be cured, but individuals may see improvement if hormone balance is restored or weight loss is achieved. Some prescription medications such as Retin-A, 15% urea, alpha hydroxyacid, and salicylic acid may reduce discoloration.

What causes thinning hair on top of the head, and what can be done to prevent it?

Thinning hair is associated with elevated androgen levels. Reducing levels and restoring hormone balance may lessen hair loss. It may also be associated with hypothyroidism. Any rapid hair loss should be brought to the attention of a doctor. Treatment possibilities include using minoxidil (Rogaine), spironolactone, hair transplants, and hair weaves

What causes excess hair on the face and other parts of the body and what can be done to prevent or remove it?

One of the more frequent cosmetic concerns among women with PCOS is the excess facial and body hair. The hair growth is triggered by either a lack of estrogen or excess androgen production.

Normalization of hormone levels may reduce unwanted hair growth, but will not remove what is already there. Birth control pills and insulin-sensitizing medications can help restore hormone balance, and spironolactone (Aldactone), a diuretic, can also be used (though not while trying to conceive as it is a Class C drug).

Another option is removing unwanted hair. Various methods are discussed below, and may be used in combination with each other.

Tweezing is inexpensive but may be time-consuming. It involves pulling out individual hairs with a pair of tweezers. It is probably best used by someone with a small amount of hair to remove. There is a risk of infection where hair has been removed.

Shaving unwanted hair is an inexpensive, quick, temporary solution. The best way to shave is to use water and some kind of shaving cream or lotion to soften the hair and moisturize the skin. Run the razor over the skin to cut the hair. This usually needs to be repeated every few days, or even every day. Razor stubble may be visible, and could cause itching or skin irritation. Contrary to what many believe, shaving does not change the texture, color, or rate of hair growth.

Bleaching works by lightening the color of dark, coarse hairs so they are harder to see, and often it also softens them a bit. It can take awhile to do, and needs to be repeated once or twice a month depending on hair growth.

Depilatories are chemical hair removal formulas that are relatively inexpensive. Use can be a bit time consuming, and probably needs to be repeated a couple of times per month. They may be hard on sensitive skin, causing burning, and don't always work on very coarse hair.

Waxing is a longer-lasting temporary solution, but can be expensive and painful. It can be done at home by melting wax on the stove or in a microwave and then spreading a thin layer over the skin in the direction of hair growth. When the wax is dry, it is peeled off against the direction of hair growth pulling out hair by the root. This is usually time-consuming and can cause skin irritation. The wax does not wash off easily. For a bit more money, this can be done at a salon. Similar to tweezing, there is a risk of infection where hair has been removed.

Sugaring is similar to waxing only cheaper and perhaps more gentle. It also may not work as well. Sugar and water are mixed into a paste and then a layer is placed on the skin, and cloth placed on top of that. When it dries, the cloth strips are peeled off removing the hairs at the roots. One advantage is that it is easy to wash any remaining solution off the skin. This solution also carries a risk of infection where hair has been removed.

Electrolysis is the most permanent solution when done correctly, but treatment needs to be done over time as not all hairs will be above the surface, and it is possible for new hair growth to begin. It helps to have hormone levels in good control before treatment as continued imbalance can contribute to new hair growth. The basic method is to zap the hair at the root with electricity. Each hair has to be done individually, so it can be time consuming, and it is fairly expensive. Home units are available where one holds the hair in tweezers while electrical pulses destroy the root. It can also be done professionally by an electrolysist using a needle to deliver electricity to the root, or with electrified tweezers similar to the home units. The needle method is more uncomfortable than the home method, and one pays by the hour. The major risks of electrolysis are electrical shock, which can occur if the needle is not properly insulated; infection from an unsterile needle or other infection control problem; and scarring resulting from improper technique.

Laser or light beam treatment can be used to burn hair off down to the root. It works mainly on dark hairs, is rather expensive, and is somewhat uncomfortable (can cause sunburn-like irritation). Some possible drawbacks are that there are about 10 different types of hair removal lasers, and not are all created equal. Three lasers have been approved by the FDA for permanent hair removal. Misuse of the laser could cause skin pigment changes. Similar to electrolysis, it helps to have hormone levels controlled before treatment for the best results.

What is a skin tag?

Skin tags (acrochordons) are benign growths that vary in appearance from smooth or rough, flesh-colored or darker than surrounding skin. They can hang from a stalk or be slightly raised above the skin. They are typically found on the eyelids, neck, armpits, upper chest and groin. They do not need to be removed unless they are irritating.

How can skin tags be removed?

A doctor can remove skin tags by freezing with liquid nitrogen (cryotherapy), electrically burning off (cautery), burning off with laser, or cutting with a scalpel or scissors. One at-home remedy is to tie off the tag with thread and let the tag wither and fall off, but it is best to have removal done by a physician.