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Dermatology Diaries

Thursday, September 12, 2013

Acne Treatment - PCOS and PCOD

pcod pcos acne
Acne making you hide your pretty face?
Increased levels of stress and deviated lifestyle habits have led to a gross change of hormonal milieu in Indian women. Polycystic Ovaries is a genetically inherited disorder which runs in families and can be inherited from either the mother or the father. With the rising trend of obesity in women and young girls a varying degree of hormonal imbalance commonly known as PCOS or PCOD has become fairly common. PCOD though a gynecological condition characterised by irregular menses, is most commonly diagnosed when patients approach a dermatologist either for persistent acne or hirsutism or hairloss.

So, as a dermatologist when do I suspect PCOS or Hormonal acne?
The suspicion usually arises during a consultation when one or more of the following factors exist:
1. Inflammatory acne with premenstrual aggravation
2. Acne mainly localized to the lower half of the face, jaw and upper neck area 
3. Acne associated with hirsutism and/or hair loss
4. Acne with irregular menstrual cycles or in known cases of PCOS
If the above factors are unclear, acne that fails to respond to conventional acne treatment of topicals, antibiotics and chemical peels is also suspected to be hormonal acne.

How does a dermatologist confirm whether the acne is hormonal?
This is a little complicated. A set of blood investigations is advised. The investigations may show frank deviation in the hormonal status or may be within normal limits. Normal test results do not rule out PCOD, in these cases ratios of various investigations are considered. Even if the laboratory tests are inconclusive the clinical diagnosis may still hold true!

When are these hormonal investigations done?
If the clinical diagnosis of hormonal acne is clear, the tests are usually advised during consultation itself so that the necessary anti-androgen medications can be started. If the diagnosis is doubtful the conventional acne treatment is started and the response is gauged. If the response is adequate, the investigations may not be required. But in case of inadequate response to 6-8 weeks of treatment, the investigations may be advised.

Do all cases of hormonal acne or PCOS acne patients require hormonal treatment?
Not necessarily. To those patient's who require quick response and are open to hormonal treatment, the medication is started at the beginning of the acne treatment. For patients who would like to avoid the hormonal medication, topical and oral antibiotics/ retinoids and chemical peels are started. I generally use advanced peels such as Agera, Obagi Blue peel Radiance, Azelan, which are capable of effectively controlling mild to moderate hormonal acne. If the response is poor after 3-4 sessions, the patient is encouraged to start the medication. If adequate response is not achieved in 6-8 sessions, then the patient is advised that oral anti-androgen medication is mandatory if control over acne is desired. 

Acne is one of the lifestyle disorders in dermatology which is completely treatable. Treatment period may vary from 1-2 months in cases of non-hormonal acne, to 3-6 months in cases of hormonal acne. Hormonal acne requires a more rigorous maintenance routine consisting of carefully customized skin care and monthly chemical peels. Find a dermatologist whom you trust and be prepared for an on going relationship. Hormonal acne patients often require a caring dermatologist committed for a lifetime.

Keep looking beautiful
Dr Niketa
dermatologist in west delhi