Abstract
Hirsutism, acne, and/or female pattern hair loss are common cutaneous manifestations of polycystic ovary syndrome (PCOS). However, while hirsutism is mainly related to androgen excess, both acne and female pattern hair loss may often depend on cutaneous alterations that are not linked to hyperandrogenism or increased androgen sensitivity. Because both acne and female pattern hair loss cannot be considered a sign of hyperandrogenism, neither should be included in the diagnostic process of PCOS without demonstration of increased levels of circulating androgens. In addition, in patients with androgen-dependent acne, the concomitant proliferation of Propionibacterium acnes in skin may determine lack of response to antiandrogen or estroprogestin therapy. Similarly, in hyperandrogenic female pattern hair loss, scalp inflammation and/or mineral or vitamin deficiencies often prevent hair regrowth. To successfully treat these patients, it is necessary that endocrinologists and reproductive endocrinologists have a good understanding of the mechanisms determining cutaneous manifestations of PCOS.
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