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Polycystic Ovary Syndrome: a Review for Dermatologists Polycystic ovary syndrome: A review for dermatologists Part II. Treatment Elizabeth Buzney, MD,a Johanna Sheu, MS,b Catherine Buzney, MS,c andRachelV.Reynolds,MDd Boston, Massachusetts CME INSTRUCTIONS The following is a journal-based CME activity presented by the American Academy of used for PCOS, including topical therapies, combined oral contraceptive pills, Dermatology and is made up of four phases: antiandrogen drugs, and insulin-sensitizing drugs. 1. Reading of the CME Information (delineated below) Date of release: November 2014 2. Reading of the Source Article Expiration date: November 2017 3. Achievement of a 70% or higher on the online Case-based Post Test Ó 4. Completion of the Journal CME Evaluation 2014 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2014.05.009 CME INFORMATION AND DISCLOSURES Statement of Need: Technical requirements: The American Academy of Dermatology bases its CME activities on the Academy’s American Academy of Dermatology: core curriculum, identified professional practice gaps, the educational needs which d Supported browsers: FireFox (3 and higher), Google Chrome (5 and higher), underlie these gaps, and emerging clinical research findings. Learners should reflect Internet Explorer (7 and higher), Safari (5 and higher), Opera (10 and higher). upon clinical and scientific information presented in the article and determine the d JavaScript needs to be enabled. need for further study. Elsevier: Target Audience: Technical Requirements Dermatologists and others involved in the delivery of dermatologic care. This website can be viewed on a PC or Mac. We recommend a minimum of: Accreditation d PC: Windows NT, Windows 2000, Windows ME, or Windows XP The American Academy of Dermatology is accredited by the Accreditation Council for d Mac: OS X Continuing Medical Education to provide continuing medical education for physicians. d 128MB RAM d AMA PRA Credit Designation Processor speed of 500MHz or higher d 800x600 color monitor The American Academy of Dermatology designates this journal-based CME activity d Video or graphics card for a maximum of 1 AMA PRA Category 1 CreditsÔ. Physicians should claim only the d Sound card and speakers credit commensurate with the extent of their participation in the activity. AAD Recognized Credit Provider Contact Information: This journal-based CME activity is recognized by the American Academy of American Academy of Dermatology Dermatology for 1 AAD Credit and may be used toward the American Academy of Phone: Toll-free: (866) 503-SKIN (7546); International: (847) 240-1280 Dermatology’s Continuing Medical Education Award. Fax: (847) 240-1859 Disclaimer: Mail: P.O. Box 4014; Schaumburg, IL 60168 The American Academy of Dermatology is not responsible for statements made by Confidentiality Statement: the author(s). Statements or opinions expressed in this activity reflect the views of the author(s) and do not reflect the official policy of the American Academy of American Academy of Dermatology: POLICY ON PRIVACY AND Dermatology. 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Persistent cookies are permanent files and must be In accordance with the ACCME Standards for Commercial Support of CME, the deleted manually. Tracking or other information collected from persistent cookies or American Academy of Dermatology has implemented mechanisms, prior to the any session cookie is used strictly for the user’s efficient navigation of the site. planning and implementation of this Journal-based CME activity, to identify and mitigate conflicts of interest for all individuals in a position to control the content of Links - This site may contain links to other sites. The Academy is not responsible for this Journal-based CME activity. the privacy practices or the content of such websites. Children - This website is not designed or intended to attract children under the age Learning Objectives: of 13. The Academy does not collect personal information from anyone it knows is After completing this learning activity, participants should be able to describe the under the age of 13. range of treatment options for the hyperandrogenic manifestations of polycystic ovary syndrome (PCOS), acne, hirsutism, and androgenetic alopecia, and demon- Elsevier: http://www.elsevier.com/wps/find/privacypolicy.cws_home/ strate an understanding of the safety and efficacy of the pharmacologic treatments privacypolicy 859.e1 859.e2 Buzney et al JAM ACAD DERMATOL NOVEMBER 2014 Dermatologists are in a key position to treat the manifestations of polycystic ovary syndrome (PCOS). The management of PCOS should be tailored to each woman’s specific goals, reproductive interests, and particular constellation of symptoms. Therefore, a multidisciplinary approach is recommended. In part II of this continuing medical education article, we present the available safety and efficacy data regarding treatments for women with acne, hirsutism, and androgenetic alopecia. Therapies discussed include lifestyle modification, topical therapies, combined oral contraceptives, antiandrogen agents, and insulin-sensitizing drugs. Treatment recommendations are made based on the current available evidence. ( J Am Acad Dermatol 2014;71:859.e1-15.) Key words: acne; androgenetic alopecia; combined oral contraceptive pills; cyproterone acetate; drospirenone; hirsutism; insulin-sensitizing drugs; polycystic ovary syndrome; spironolactone. Although patients with polycystic ovary syn- drome (PCOS) often present to dermatologists Abbreviations used: with cutaneous concerns, it is essential to cOCP: combined oral contraceptive pill provide education regarding the metabolic and CPA: cyproterone acetate EE: ethinyl estradiol fertility-related implications of PCOS and to form a FDA: US Food and Drug Administration multidisciplinary team that includes a primary care FG: FerrimaneGallwey physician and an endocrinologist. Understanding ISD: insulin-sensitizing drug PCOS: polycystic ovary syndrome patients’ reproductive goals and medical health SHBG: sex hormone binding globulin allows providers to develop a comprehensive med- TZD: thiazolidinedione ical plan. The decision to begin pharmacologic VTE: venous thromboembolism treatment for dermatologic manifestations of PCOS must be tailored to each woman’s specific concerns. Pharmacologic treatment is not necessary for all PCOS population and are useful first-line patients with PCOS, and mild forms of hirsutism, agents acne, and androgenetic alopecia may be satisfacto- Lifestyle changes rily managed with standard nonhormonal agents Lifestyle changes are often recommended as first- (Table I) that—aside from laser hair removal, mino- line treatment for PCOS to benefit overall health. xidil, and eflornithine—will not be reviewed here.1-4 Studies examining dietary interventions show In addition, a discussion of weight loss, diet, and conflicting effects on hirsutism, likely influenced by exercise in obese patients may be helpful in type of restrictive diet and study length, because managing cutaneous symptoms. This review focuses studies often span weeks to months, which is not primarily on pharmacologic management of PCOS, long enough to observe biologic changes on because many patients find standard topical agents dermatologic
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