SAN ANTONIO — Address the underlying androgen excess when a woman presents for correction of cutaneous effects of hyperandrogenism, Dr. Ellen E. Wilson said at a meeting of Skin Disease Education Foundation.
Polycystic ovarian syndrome (PCOS) is the most common etiology of hyperandrogenism. “Dermatologic manifestations include hirsutism, acne, acanthosis nigricans, and androgenetic alopecia—in that order,” said Dr. Wilson, a reproductive endocrinologist at the University of Texas Southwestern Medical Center in Dallas.
A contraceptive pill, patch, or ring regimen can regularize periods and treat the effects of hyperandrogenism. Low-dose oral contraceptives decrease free testosterone levels, with the progestins desogestrel, gestodene, and norgestimate being associated with greater reductions. “The bottom line is probably any low-dose formulation produces an overall similar clinical response,” she said.
Treatment with hormonal suppression will be needed for at least 6 months before there is an observable difference. “I counsel patients that it takes time,” Dr. Wilson said. “For hirsutism, often I recommend they go to a dermatologist for hair removal, and I tell them there should be no new growth.” Patients with PCOS may remain on oral contraceptives through their 40s, often until they are menopausal.
If oral contraceptives are not enough, “we will supplement with spironolactone,” Dr. Wilson said. “Spironolactone is a potential teratogen, so we feel more comfortable if they are already on an oral contraceptive.” Spironolactone is effective in doses of 100–200 mg/day.
Vaniqa (eflornithine) is approved for hirsutism as a twice-a-day local treatment. “It is expensive and works in one-third to two-thirds of women,” she said. “It is something they can try.”
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