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Hair & acne - management & treatment

Excess hair on the face and body (‘hirsutism’), hair loss from the scalp (‘alopecia’) and acne are often symptoms of PCOS and caused by high levels of androgen hormones.

These symptoms often cause considerable distress for those with PCOS and it is important to know that treatments are available. Learn about the different ways to manage these symptoms, including waxing, laser hair removal, electrolysis, hormonal contraceptives, drugs for insulin resistance and anti-androgen drugs.

Topics on this page

Many women with PCOS say that excess facial and/or body hair growth is one of the most difficult symptoms to cope with. This is possibly because it is a symptom that can be visible to others, and can make them feel less feminine. It can have a negative impact on how a woman feels about her body.

Hirsutism, scalp hair loss and severe acne can all challenge our ideas of femininity: they can cause women to feel that they do not fit the image of how a woman is ‘supposed’ to look. As such, these symptoms can affect your body image, self-esteem and sexuality, so do seek help in coping with these features.

It is important to discuss with your doctor how much these features concern you. Remember, there is a range of options to assist you in managing these symptoms.

Cosmetic treatments

Acne

Creams or gels that reduce pore blocking, oil production by the skin and inflammation can be used to treat acne. Your doctor can advise you about these options.

Excess face and body hair

Waxing, laser hair removal and electrolysis can be useful measures for reducing body hair growth. Of these, laser is the treatment most likely to result in a significant reduction in excess hair growth. However, repeated treatments are needed over time, and treatment can be costly. If you are considering laser hair removal, it is important to have this performed by a trained professional who uses the correct machine or technique for your skin type. Results can vary depending on your hair colour and skin type.

Some dermatologist practices offer laser hair removal and have particular expertise in treating women with PCOS. They will be able to tell you whether laser hair removal will work on your skin type.

Young woman smiling

Medical treatments

Scalp hair loss, excess facial and body hair and acne can be treated by:

  • The combined oral contraceptive pill
  • Anti-androgen drugs
  • Other medications for acne and hair loss

The combined oral contraceptive pill (COCP)

The oral contraceptive pill (‘the pill’) reduces ovarian production of testosterone and other androgens. It also increases the body’s production of sex hormone binding globulin (SHBG). This reduces the activity of testosterone and reduces the symptoms of androgen excess, including scalp hair loss, excess facial and/or body hair growth and acne.

If the pill is not successful in reducing your symptoms after 6-12 months, it can be used in combination with an anti-androgen medication. Your doctor will work with you to find the best and most effective treatment for you.

Anti-androgen drugs

Anti-androgens are available for use in more severe cases of scalp hair loss, excess hair and acne. They should be considered in treating hirsutism only after cosmetic therapy and 6-12 months of the oral contraceptive pill has failed to produce improvement.

Anti-androgens can be harmful to an unborn child, so it is important that you don't get pregnant while taking these medication. For this reason anti-androgens must be used in combination with a form of contraception.

Spironolactone (sold as Aldactone)

A diuretic (fluid-reducing) tablet that also reduces androgen production and blocks androgen activity in the body.

How it is used
  • Must be used with some form of contraception to avoid pregnancy and prevent irregular bleeding
  • Should be used only in women who are not trying to conceive due to the possibility of foetal abnormalities (birth defects)
Side effects
  • menstrual irregularities
  • stomach upsets
  • headaches
  • dizziness
  • lethargy

Cyproterone acetate (sold as Androcur)

How it is used

Must be used only with the hormonal contraceptive pill 10 days of each cycle.

Side effects
  • weight gain
  • depression
  • reduced libido
  • tiredness

Finasteride (sold as Proscar or Propecia)

reduces the binding of androgens to the target tissues. A treatment for acne, hirsutism and alopecia, but is not commonly prescribed in Australia.

Other medications for acne and hair loss

Isotretinoin (sold as Roaccutane)

Isotretinoin can only be prescribed in Australia by a dermatologist (skin specialist) for severe acne. It works by shrinking the sebaceous glands (glands that secrete substances onto the skin surface) and by reducing sebum production (sebum is made from cholesterol and fats and is one component of the oil on the skin’s surface).

This should be used only in women who are not trying to conceive, and effective contraception such as the oral contraceptive pill must be used when taking this treatment, as there is a possibility of foetal abnormalities (birth defects). Side effects include dry skin and eczema.

Minoxidil (sold as Rogaine, Regaine, Avacor)

Minoxidil is a liquid or foam that is massaged into the scalp and helps to prevent hair loss. Side effects include scalp dryness and itchiness. Some dermatologists prescribe minoxidil in tablet form, often together with spironolactone.

PCOS - young woman in a consultation

The role of diet in acne

The role of diet in the development of acne has been much debated by researchers. The typical Western diet is believed to contribute to acne because of its high glycaemic load and high intake of calories, processed foods, fat, meat and dairy products such as cow’s milk.

There is very little research looking at diet, nutrients and acne specifically in women with PCOS, but it is now more widely accepted that a diet with a high glycaemic load contributes to acne generally.

Glycaemic load

Glycaemic load, also called GL, is a similar concept to glycaemic index (GI) and refers to the effect of carbohydrates on blood sugar levels. GL also takes into account the amount of carbohydrate present in the foods. Refined carbohydrates, for example, white bread, white rice and processed ‘junk’ foods, are high-GI foods. They cause blood sugar levels to rise sharply.

A high blood-sugar level resulting from a high-GL diet increases insulin signalling and the activity of a hormone known as insulin-like growth factor-1 or IGF-1. The end result of increased levels of IGF-1 is an increase in oil (sebum) production in skin cells, where acne develops.

Insulin and IGF-1 also increase the production of androgens (such as testosterone) from the adrenal glands, and increase how readily available these hormones are. It is well known that androgens play a role in the development of acne.

There is not much research looking at GI/GL diets and acne; however, it is generally accepted that a low-GI diet can improve acne. The Australasian College of Dermatologists recommends a low-GI diet as part of the management of acne.

For further details on how to follow a low-GI/GL diet go to Healthy living.

Dairy

More recently, the role of dairy products has been suggested to worsen acne. However, there is ongoing controversy about this, and the research is inconclusive. Milk and dairy foods have a low GI but, interestingly, they also significantly increase the levels of IGF-1.

Natural therapies

Over 70% of women with PCOS in Australia use natural and complementary therapies to improve one or more aspects of their health. Get more information on how natural therapies can help manage excess hair and acne here.

Taking action

To make a decision on the best therapy to help with problems with hair and acne, discuss your options with your doctor and seek the best quality health care you can. Prioritise what is most important to you and communicate this with your doctor.

Group girls table smiling pcos booklet

PCOS booklet

Read more on PCOS in our booklet 'Understanding polycystic ovary syndrome: All you need to know'

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at September 2019.

References

  • 1
    Monash University. International evidence-based guideline for the assessment and management of polycystic ovary syndrome. 2018. Melbourne, Australia.
  • 2
    McCartney CR, Marshall JC. Clinical practice: polycystic ovary syndrome. N Engl J Med. 2016; 375(1):54–64.
  • 3
    Goodman NF, Cobin RH, Futterwelt W, Glueck JS, Legro RS, Carmina E, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Androgen Excess and PCOS Society Disease State Clinical Review: guide to the best practises in the evaluation and treatment of Polycystic Ovary Syndrome – part 1. Endocr Pract. 2015 Nov; 21(11) 1291–300.
  • 4
    Fiedler F, Stangl GI, Fiedler E, Taube KM. Acne and nutrition: a systematic review. Acta Derm Venereol. 2017 Jan 4;97(1):7–9.
  • 5
    Romańska-Gocka K, Woźniak M, Kaczmarek-Skamira E, Zegarska B. The possible role of diet in the pathogenesis of adult female acne. Postepy Dermatol Alergol. 2016 Dec;33(6):416–20.
  • 6
    Pappas A, Liakou A, Zouboulis CC. Nutrition and skin. Rev Endocr Metab Disord. 2016 Sep;17(3):443–8.
  • 7
    Katta R, Desai SP. Diet and Dermatology: the role of dietary intervention in skin disease. J Clin Aesthet Dermatol. 2014 Jul;7(7):46–51.
  • 8
    Paoli A, Rubini A, Volek JS, Grimaldi KA. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. Eur J Clin Nutr. 2013 Aug;67(8):789–96.
  • 9
    https://www.dermcoll.edu.au/atoz/acne-vulgaris/
  • 10
    Kwon HH, Yoon JY, Hong JS, Jung JY, Park MS, Suh DH. Clinical and histological effects of a low glycaemic load diet in treatment of acne vulgaris in Korean patients: a randomized, controlled trial. Acta Derm Venereol. 2012;92(3):241–6.
  • 11
    Smith RN, Mann NJ, Braue A, Mäkeläinen H, Varigos GA. The effect of a high-protein, low glycemic-load diet on biochemical parameters associated with acne vulgaris: a randomized, investigator-masked, controlled trial. J Am Acad Dermatol. 2007 Aug;57(2):247–56.
Last updated: 01 September 2020 | Last reviewed: 01 September 2019

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