Pharmacologic management for polycystic ovary syndrome: Hirsutism and acne

Acne vulgaris and hirsutism are highly distressing and common issues in females presenting with polycystic ovary syndrome (PCOS). It takes many months to see the clinical response of the drugs used to treat hirsutism, and it may take more than a year to observe the full benefits. Cosmetic and direct hair removal measures, photoepilation, antiandrogen receptor antagonists, cyproterone acetate, and eflornithine are widely used for the management of hirsutism. Acne, meanwhile, can be treated with different topical and systemic medicines. Treatment of choice depends on the severity of the acne and its impact on the quality of life of patients. The different treatment modalities include topical and systemic antibiotics, retinoids, antiandrogen drugs, and androgen suppression by oral contraceptives. The contraceptive measures should be prescribed while taking antiandrogen therapy and the optimal contraception choice in this setting is a combination oral contraceptive (COC) because it is also the best treatment for irregular menstruation that is often caused by antiandrogens. Topical treatments usually affect all the key factors responsible for acne development except for sebum production, whereas systemic therapies affect all the steps responsible for acne production. Oral antibiotics are commonly prescribed drugs and are usually prescribed for extensive truncal and facial acne and moderate facial acne that do not respond to topical therapies. A comprehensive analysis of evaluating photodynamic therapy and laser light sources for acne treatment found that most light sources help treat inflammatory acne lesions in the short term, whereas photodynamic therapy provides the most consistent outcomes.