Polycystic ovarian syndrome, commonly known as PCOS, is a condition which affects the ovaries and how they work. The PCOS Awareness Association states that approximately 10 million women suffer from the condition worldwide, and over half are currently not aware that they have this hormonal condition.
Increasingly, women are turning towards aesthetic treatments in order to address and control the most common side-effects of this hormonally influenced condition. Excessive hair growth and hormonal inflammatory acne are the most common symptoms.
These are usually linked by higher levels of hormones called androgens being produced within the ovaries, which in turn directly affect oil production levels within the skin and stimulate hair growth.
PCOS can interrupt hormonal signals from the pituitary gland which throws off the harmonious balance and causes higher levels of testosterone. This increased androgenic activity will stimulate the sebaceous glands which are responsible for producing and regulating sebum production within the skin. When too much sebum and dead skin builds up within a follicle, it will become trapped underneath the skin alongside bacteria, leading to inflammation and acne.
I typically see inflammatory acne in my PCOS clients, usually with a combination of papules and pustules. It’s worth noting that acne is usually not limited to the face, and can appear on the chest, back and arms due to increased hair follicles and sebaceous activity in these areas.
Aestheticians can safely treat acne graded 1-3, however, for clients that present with hard cystic nodules and severely graded acne, dermatologist referral is necessary. For mild to moderate acne I find detoxifying bespoke facials and chemical peels very effective to control inflammation and clear out the sebaceous gland alongside destroying the cutibacterium acne causing bacteria. Chemical peels such as salicylic, glycolic, Jessner and TCA are available in various strengths to tailor to individual needs and are additionally highly effective at combating the post-inflammatory erythema and hyperpigmentation that usually is left behind.
Once the active breakouts are under control, microneedling is the preferred choice of treatment to improve any textural scarring. Needle depth is dependent on the facial region and should be tailored to the thickness of the skin but would typically be between 0.5mm- 2mm for textural scarring. In conjunction I like to ensure clients are on a regime of medical-grade skincare at home, as this supports clinical treatments and helps as a preventative measure long term.
The cause of acne in this instance is internal, so while these solutions are great at improving the skin externally, it will be a continuous cycle if the hormones are not under control. There are dietary and lifestyle changes that can also help minimise inflammation and reduce insulin resistance.
Many individuals with PCOS have found cutting out high glycemic carbohydrates and reducing dairy and gluten intake has helped improve their skin. I also recommend probiotics and supplements containing zinc to additionally support skin health.
Excessive hair growth
Excess unwanted hair growth is usually distributed in areas such as the facial region, torso and buttocks. Class 4 laser hair removal is an excellent choice for managing typical and atypical hair growth associated with PCOS. The results are often life changing for patients, as I have experienced first-hand.
A minimum course of eight sessions is needed to achieve significant hair reduction, however it’s realistic to expect more treatments may be required, particularly when there are underlying hormonal influences. However, sometimes laser hair removal can go the opposite way and actually cause increased hair growth, known as paradoxical hypertrichosis.
When receiving hair removal treatment approximately 10% of individuals can experience this unwanted increase of hair post-treatment, but with PCOS clients it is very important to be aware that they are statistically at a higher disposition to experience this than those that do not have underlying hormonal factors contributing to hair growth.
Unlike hirsutism (excessive hair growth in a male-like pattern, i.e. on the face, chest and back), paradoxical hypertrichosis is the term given for stimulated hair growth which can develop anywhere on the body. When administering laser hair removal, it is advisable that additional precautionary measures be taken in the treatment area to reduce the risk of this potentially occurring.
Applying additional pre and post-cooling with ice packs and cryogenic cold air, particularly on hormonally influenced areas, can really help to minimise the transference of residual subtherapeutic heat to surrounding areas, which can stimulate the current dormant vellus hair follicles.
There isn’t much definitive evidence to as why this happens, but it is believed if a hair follicle is heated under approximately 65°C, the subtherapeutic temperature does not carry enough effective energy to destroy the germ cells which produce the hair shaft itself.
I find it is extremely important to only treat within the parameters of where the active hair growth lies, and cross reference with patients to avoid surrounding areas becoming stimulated. From my own experience I have noted higher instances of paradoxical hypertrichosis – primarily in the facial regions – of individuals that are classified as a Fitzpatrick IV or higher.
It is important to rule out any contraindications to ensure the best course of treatment plan. For example, if an individual is concerned about excessive facial hair growth in addition to acne, certain ingredients which increase cellular turnover, such as vitamin A and BHAs, will increase the skin’s photosensitivity and therefore the risk of adverse reactions when a laser is used within the same area.
It is equally imperative that a thorough consultation and medical history is carried out, prior to conducting any clinical treatment to ensure the most effective and safe treatment plan.
Benisha Williams is an aesthetic practitioner based in London. She currently works for The Harley Medical Group and has years of experience in the aesthetic industry, particularly within the use of class 4 lasers. She has trained and educated practitioners and nurses with laser treatments for hair removal, pigmentation and vascular rejuvenation.