The PCOS Spectrum:
Understanding Symptoms and Skin Care Strategies

Hello everyone, and welcome back to The Skin Report. Today we are going to talk about hot questions about PCOS. And I have Shaheera here who is, as you know, Director of Brand and Communications at ReNewMD Medical Spas and Skin by Dr. Sethi. And she’s going to go over some commonly asked questions on our social platform pertaining to PCOS and all the side effects from it.

Hi Shaheera. Thank you for being here.

Thank you.

I find PCOS… I feel like it’s a very common, most… Not most searched for, but it tends to be like… I have my phone out. When you Google PCOS or PCOS acne, then you get this flood of search results, which means that people are obviously really, really curious about it. So, let’s talk about PCOS. From just what ages does it generally affect?

A lot of times, you don’t know you have PCOS until you start showing certain symptoms of it. There aren’t very good ways of always testing for PCOS. When you are in your late teens and going into your 20s is generally when you are diagnosed with PCOS. And because PCOS is a spectrum of disease, it could be because you have irregular periods, it could be that you have normal periods but you’re having a lot of hair growth, a lot of acne. And sometimes, if the PCOS is very advanced, there’s going to be a lot more weight gain, hair growth in the face and the chest, and hair loss in sort of like a male pattern balding in the scalp. So when I encounter young women with PCOS, it’s usually in the context of excess hair growth, acne, and hair loss.

When they come in and they’re addressing these multiple symptoms, where do you begin the treatment of the side effects? Do you begin with like, let’s treat this first, then we treat this, or do you kind of do them all at once?

Yeah. Actually, it’s kind of like an all-at-once approach. Because it’s the same signal for all of these things, right?

The most common reason why I will see a patient is that they’re experiencing excess facial hair growth. They’re shaving their face almost every day or they’re waxing every three or four days, which is actually causing more skin irritation that is not related to PCOS.

Yes.

It’s causing hyperpigmentation in the chin, in the upper lip. And it’s very disturbing. You can cover it up with makeup. You cannot cover up excess hair growth with makeup. And then of course, there’s also more acne production. But honestly, I think the acne almost doesn’t bother them as much as the hair growth and the hyperpigmentation that it results in.

So, the most common question I get is, can I do laser hair removal and is it going to be effective? And the answer is yes and no. And that’s because the laser hair removal, yes, it’ll permanently destroy hair follicles. But when you have PCOS, you’re waking up more and more hair follicles outside of your dormant phase, and you are going to not experience the same results from laser hair removal than compared to somebody without PCOS.

So, the first thing is I ask them to get on a medication called spironolactone. Spironolactone is not a hormone. Because a lot of them have been to their gynecologist and they’re already taking [inaudible 00:03:50]. Right, oral contraceptives. And they’re not seeing a big change. I like to put people on spironolactone. Spironolactone is actually a heart medicine. Very, very safe. And it essentially affects your adrenal glands to make you kind of lower your testosterone production. And that effect for some reason causes a reduction in abnormal hair growth. It also is a great solution for acne caused by PCOS.

Sorry to interrupt you. The testosterone imbalance, they’re producing more of it, is that, and we want to be clear, that’s what’s causing the excess hair growth. Is that also causing hair loss or balding?

Yes. If the PCOS is more advanced and there’s so much more testosterone production, there will be balding and then facial hair growth. Yes. So, spironolactone I feel is a great thing to start. Now, as soon as you start spironolactone, yes, we can get you started on laser hair removal. I think it’s a great option. Laser hair removal is very safe for darker skin tones if you’re using a diode laser or an Nd:YAG laser. And then, you are going to start seeing that facial hair growth reduction like you normally would if you did not have PCOS. You also don’t need to be on spironolactone for the rest of your life. I recommend, “Hey, let’s get you started on it for a year or two and then take you off.” Because your hormones are going to change. You’re a young woman, your hormones are constantly fluctuating.

And then, the other thing is… Now, let’s talk about correction of hyperpigmentation. That’s another question that I know that you’re seeing on social media.

Yeah. How do they treat it? Well, how do they treat it at home? How do they treat it with skincare? Generally, they want to look for an acne solution. And also, the micro needling, which I know you recommend to do it in the medical aesthetics professional setting. But where can people begin treating their acne and hyperpigmentation with PCOS?

The first thing with PCOS is start on spironolactone, you will already see a huge reduction in acne and facial hair growth. Start laser hair removal at the same time. And then, once you’ve done that for a few months, now we can really get into skin care, skin treatments and have great results. But it does require, I think, the right medication orally. We won’t get anywhere without that.

A lot of people ask, “Well then, should I do electrolysis if I have PCOS?” I think electrolysis has its space in permanent hair reduction, but I also feel that it can be very traumatic on the skin, especially if you have a darker skin tone. And I don’t think that a lot of electrologists, even though they primarily work with females with darker skin tones, have had the training to avoid hyperpigmentation. So, again-

From where the hair follicles-

Yeah, where the current is delivered in the process. And electrolysis is a weekly process, so there’s just too much trauma suffered by the skin. So I usually say no.

Please start an oral medication, which is very safe, effective, laser hair removal. That’s a great pathway.

When do they begin something like microneedling if they… Keratosis pilaris, am I pronouncing that correctly? Or strawberry skin. That ends up becoming… In general, is that hyperpigmentation?

No. Or, kind of. When we were talking about PCOS, we were talking about excess facial hair growth. Now, if you switch over to strawberry skin, strawberry skin is basically… Its medical term is keratosis pilaris, KP. And it’s basically clogged hair follicles that are now so clogged that they look like little black marks and make your skin look like strawberry. And you can have it if you have PCOS, but you can have it even normal. You don’t have to have PCOS to have keratosis pilaris. And generally, of course I would say almost always, it’s present in skin of color.

Treating keratosis pilaris, there is sort of a three-pronged strategy to it. Laser hair removal, number one. You need to take away that excess hair growth and take away your daily shaving routine because that is causing that blocked follicle. Second, good exfoliation. Exfoliation with the right product so you’re not stripping the skin of its skin barrier. Again, my favorite… Or actually not so favorite today, St. Ives Apricot Facial Scrub, not a good idea for keratosis pilaris. Because it’s actually stripping your skin and making micro tears. Instead, use something a little finer but be consistent. And then third, hydration. Don’t let your skin get dry.

If you do all those three things consistently for a few weeks, you will actually start seeing great results.

I think this is amazing because you’ve covered the PCOS side effects when it comes to your skin, even your hair, how they form, when they tend to form, and then also the kind of start to sort of finish or the progress and step-by-step of how to treat those side effects in a very effective manner so they do not reoccur.

Yes. And the other thing I want to mention before we close out this episode is, there are now creams for hair removal. And they’re not hair removal creams, they’re creams that hormonally will suppress hair production. I don’t like them. Because again, they’re treating a symptom. You can make the argument that laser hair removal is treating a symptom too of PCOS. But I don’t let women in my practice start laser hair removal until I know that they’ve started spironolactone, because it wouldn’t be fair to them, it wouldn’t be the right thing to do. So instead of investing in these creams and different kind of hair removal practices, invest in getting on the right medication, attenuating your hormones, then taking the safest, most effective way of hair removal, laser hair removal.

And you’re going to spare your skin of all the hyperpigmentation that usually results with that.

If anyone has any questions about PCOS, just best, how tos, where do you direct them usually?

Yes, definitely leave us a comment, ask a question on our YouTube page. We’re always checking those, all our social platforms. And again, thank you everyone for being here today. Please remember to subscribe, share, and like. And yes, if you have any questions, you can always leave them in the comments.