Endocrine Abstracts

Hyperandrogenism in PCOS often manifests itself with the cosmetically disfiguring problems of acne, androgenetic alopecia and hirsutism. These conditions cause considerable psychological morbidity in women with PCOS.

Specific treatments for these cosmetic problems should be considered in addition to hormonal or other therapy.

Topical retinoids are an appropriate first line therapy for most cases of acne particularly when comedones predominate. These can be effectively combined with a topical antimicrobial for more inflammatory acne and benzoyl peroxide preparations may be of additional benefit. For more severe acne prolonged courses of oral antibiotics are indicated. Oral isotretinoin may be necessary for the most severe or non-responsive acne.

Androgenetic alopecia may improve on treatment with topical minoxidil with continued long term treatment being necessary to maintain any benefits which accrue.

Wigs play an important role in the management of severe androgentic alopecia.

Physical treatments of hirsutism involve both temporary and permanent hair removal. Temporary hair removal methods include shaving threading, plucking, waxing and sugaring. Bleaching of hairs can also be of cosmetic value.

Until recently electrolysis was the only long lasting method for hair removal. Photoepilation using lasers or intense pulsed light sources is now widely utilized and the field continues to evolve.

Topical eflornthine cream reduces the size and growth rate of terminal hairs by inhibition of L-ornithine decarboxylase a rate controlling enzyme involved in hair growth. This may be effective for facial hair reduction in up to 70% of hirsute patients and can be combined with laser therapy.