It is not uncommon for people to find acne, pimples, or some discolorations on their skin in different body parts – sometimes deciding whether they are normal or if they mean something can be confusing.
However, if you are someone who is diagnosed with PCOS, these changes in the skin should not be overlooked. Hormonal imbalance in PCOS can show up as acne, which is usually deeper and harder to resolve and some may even be suffering from hidradenitis Suppurativa (HS).
Hidradenitis Suppurativa
Hidradenitis Suppurativa or HS is a chronic skin condition that is shown up by painful lumps in the skin that are often deep to resolve. Although HS can look similar to acne, it is not acne. Because HS is not a very familiar term, many people think these are normal acne or boils and don’t really know how to treat them. Usually, HS begins to develop in areas where there is thick hair such as the armpits or the groin and in some cases, in the breast areas. Rarely does it happen on the face or neck?
Polycystic ovary syndrome
PCOS is a chronic hormonal disorder that is an outcome of a combination of causes including genetic, lifestyle, and hormonal imbalances. The two hormones that are mainly responsible for causing the symptoms of PCOS are androgens and insulin. However, PCOS is not just a disorder that affects your reproductive health, it affects your metabolic and psychological health as well. In fact, PCOS if left untreated can increase your risk of developing many health complications in the future including type 2 diabetes, cancer, infertility, and heart conditions. Some of the common symptoms of PCOS include:
- Irregular periods
- Acne
- Weight gain
- Hirsutism i.e. excess hair on the face and body
- Scalp hair loss
- Mood disorders
The Link Between Hidradenitis Suppurativa and PCOS
There is limited evidence around a direct link between PCOS and HS. But it is said that genetics, inflammation, and hormones can all be responsible for having a role in this connection. The second most common comorbidity of HS is PCOS.
Being diagnosed with PCOS can put you at risk of developing HS. Studies have shown that there is a link between the effects of PCOS on the skin such as in developing cystic acne, seborrheic dermatitis, and HS.
Since PCOS can take time to be diagnosed, it is possible to be diagnosed with HS first. So if you have HS and are showing other signs of PCOS such as excess hair on your face and body, scalp hair loss, irregular periods, or trouble conceiving, you should speak to your doctor to get tested.
Hidradenitis Suppurativa & PCOS Symptom
Although HS and PCOS are both fundamentally different conditions, they can also coexist at the same time making it seem as if one affects the other. Certain symptoms of HS and PCOS that can overlap are:
- Weight gain
- Acne
- Skin problems
- Mood disorders such as depression and anxiety
And the symptoms of both these conditions can be worsened due to weight gain, hormonal imbalance, and stress,
Chronic Stress
Stress is a known factor to worsen both the symptoms of PCOS and HS. In PCOS, elevated levels of cortisol (which is a stress hormone) can promote weight gain and eating disorders. Living with HS can also cause emotional stress and affect body image issues. Feelings of embarrassment and feeling conscious about one’s appearance is common in both conditions. Chronic stress can over time give rise to many health problems.
Changes in hormone levels
The underlying hormonal changes are one of the main causes of PCOS. Hormonal imbalance can cause menstrual irregularities, hirsutism, weight gain, acne, scandal hair loss, and affect fertility.
Hormones are also believed to be involved in the development of HS. Hormones can affect the hair follicles and increase the oil production in the skin, which can perpetuate the cycle of skin abscesses and lesions.
Inflammation
Chronic inflammation can be an underlying factor of both HS and PCOS. In PCOS, chronic, low-grade inflammation can cause a number of symptoms and also increase your risk of developing future health complications.
HS is known to be an inflammatory disease of the hair follicles. Having both HS and PCOS can worsen the inflammatory process and increase symptoms of both conditions.
Weight Gain
Weight gain can be seen in both conditions. In fact, weight gain is a commonly seen symptom of PCOS. In HS particularly, being overweight can put you at a higher risk of developing HS and of a severe kind. In some cases, a severe form of HS can make it difficult to exercise due to open wounds and pain.
For both conditions, it is well established that being overweight is a risk factor. Maintaining a healthy weight can help manage symptoms of both HS and PCOS and prevent the development of further complications.
Treatments for Hidradenitis Suppurativa & PCOS
Treatment for both these conditions involves following a healthy lifestyle along with the required medications. For HS particularly, medications to help reduce infections, pain, topical treatment, and wound care can help make the condition more manageable.
Birth Control Pills
With the hormonal imbalance associated with PCOS, using combined oral contraceptive pills can help treat the hormonal imbalance by providing the right level of hormones in the form of these pills. Birth control pills can help regulate periods and restore the normal functioning of the ovary. Certain birth control pills also have anti-androgenic effects and can help lower the levels of androgens too.
Spironolactone
Spironolactone is a medication that is used to treat HS and manage its symptoms. In one study it was shown to decrease the lesions, and pain, associated with HS and slow its progression.
In another study, it was found that a low dose of the drug was helpful to lower the levels of male hormones that are usually elevated in women with PCOS and are associated with symptoms such as acne, and scalp hair loss.
Finasteride
For the treatment of HS, a study found that the use of Finasteride can help in the management of advanced HS symptoms and can also possibly resolve the symptoms. Finasteride is an anti-androgenic drug i.e. it helps lower the levels of androgen in the blood.
Those who are diagnosed with PCOS and who were treated with finasteride also saw a reduction in hirsutism i.e. excessive facial hair growth. Finasteride, along with the use of other drugs such as spironolactone, can help benefit people with PCOS.
Conclusion
Hidradenitis Suppurativa can coexist and have overlapping symptoms. Although more research is required to understand how the 2 conditions are exactly linked together, we know that certain factors such as stress and hormones can worsen the symptoms. Focus on following a healthy lifestyle such as following a balanced diet, regular physical activity, managing stress, and getting good sleep.
