Aesthetic treatment approach
The treatment approach has to be holistic, believes Dr Shah. “This will first include lifestyle modification – exercising every day, correcting the diet pattern (suger-free, no dairy, less carbs, high protein), with high vitamins and hydration,” she says, adding that if the person has insulin resistance along with PCOS, tablet Metformin is prescribed to reduce the insulin resistance and improve insulin sensitivity. If the patient is suffering from irregular periods, hormonal supplements such as tablet Ginette or Crisanta are added. Also, the primary treatment of acne should include antibiotics with topical creams, topical antibiotics and gels such as benzoyl peroxide or adapalene. “If the acne is persistent and long lasting, which is severe and leaves scars, and patient has already been taking antibiotics for a long time – Iwould shift to the tablet isotretinoin along with hormonal correction and metformin, if needed.”
Apart from this, aesthetic treatments like lasers and chemical peels have a role to play. While intense pulsed light (IPL) is Dr Shah’s favourite, she also recommends peels like salicylic peel and black peel as good for inflammatory acne. “I combine treatments and give patients utmost satisfaction in just a few months. Once the acne subsides, the comedones, the whiteheads, blackheads production has almost stopped and the patient’s skin looks clear, we stop medication and focus on maintaining a healthy lifestyle and recommend maintenance treatments once in two to three months to avoid reoccurrence of the acne.” After the acne is cleared, for scarring, treatment such as fractional laser resurfacing, microneedling RF or erbium glass are available.
Going by his approach, Dr Ganjoo says, “If PCOS is associated with acne, as dermatologists, we need to manage the patients’ lifestyle, counsel them and emphasise on the need to lose weight. If they are not overweight, they still have to follow an active lifestyle where they exercise regularly and eat healthy.” This results into good evidence of hormonal derangement, which can be treated in addition to the dermatologist’s conventional treatment for acne. The doctor may also have to consider giving anti-androgens, sometimes you may have to give them oral contraceptive pills along with the anti-androgens and that along with the conventional treatment takes good care of the acne. Then you may have to add aesthetic procedures like chemical peels, sometimes lasers like IPL or these days we have the carbon peels.