SAN DIEGO – Correctly diagnosed and adequately treated polycystic ovary syndrome can appreciably improve acne in a select group of female patients, according to Dr. Anne W. Lucky.
Dr. Lucky offered tips on evaluating and treating acne and PCOS at the annual meeting of the American Academy of Dermatology. She said that PCOS should be considered in female patients with early onset acne, acne that is refractory to conventional therapy, relapse that occurs after treatment with isotretinoin, persistence of acne beyond adolescence, or late onset of acne, she said.
Several laboratory tests are typically used to diagnose PCOS but agreement on which tests to use is limited. "This is somewhat controversial," said Dr. Lucky, a professor of dermatology at the University of Cincinnati. She recommended the following tests: free testosterone, DHEAS (dehydroepiandrosterone sulfate), and the ratio of LH (luteinizing hormone) to FSH (follicle-stimulating hormone). "If I have a good suspicion or find abnormalities – [I include] fasting glucose and insulin and a fasting lipid profile," she said.
Treatment options include combination oral contraceptives, glucocorticoids (for specific adrenal abnormalities), and anti-androgens among others.
"By and large, oral contraceptives are the No. 1 choice. I mentioned combination contraceptives because it’s the estrogen that’s helpful. Progesterone-only contraceptives can actually worsen acne," Dr. Lucky said. "We don’t treat girls before menarche because they don’t have a risk for pregnancy and we might influence bone growth if we treat too early. You can suspect PCOS very early but you may have to suspend your treatment until they get a little older."
Using contraceptives – especially in girls or adolescents -- usually involves discussions with a gynecologist, a parent, and the child. "Our biggest hurdle is that the teenage population has heard the word on the street that the pill is going to make them fat and they don’t want to take it. Actually [the gynecologists that I work with] tell me that the studies show that some children gain weight, some lose weight, but most stay the same weight with the combination pills," she said.
In the United States, spironolactone is the only antiandrogen treatment option. It works by being a competitive inhibitor of androgen receptors. The drug does not lower serum androgen levels, but it prevents the action of androgen – increasing estrogenicity. However, the use of spironolactone for PCOS is considered off label. The drug is indicated for the treatment of hypertension and the label carries a warning that it should only be used for this indication, Dr. Lucky noted.
Dr. Lucky reported that she has financial relationships with Amgen, Galderma, and Johnson & Johnson.