Q I'm a 30-year-old woman and, since December 2003, I have suffered from hair-follicle abscesses at the back of my head (folliculitis) and ringworm on my forehead. Recently, I was diagnosed with polycystic ovarian syndrome (PCOS). Could this be responsible for my skin conditions, hirsuitism and infertility? Please explain the cause of PCOS and the treatments for my skin problems. - Nubila Choudhry, Middlesex
A Although associated with cysts on the ovaries, PCOS also causes metabolic disturbances that can lead to your symptoms.
Women with PCOS overproduce male hormones such as testosterone, leading to weight gain, acne, excessive body hair (hirsuitism) in some places - and male-pattern hair loss in others - and menstrual problems. Doctors may prescribe the Pill and other hormones for these problems. But, these days, many believe that insulin is the key to the domino effect of symptoms seen in PCOS. For this reason, insulin-sensitising drugs, such as metformin, are now added to the conventional treatment regime.
When the body fails to use insulin properly, the pancreas releases more and more of it. In PCOS women, this insulin surplus can trigger the ovaries to boost androgen (male hormone) production.
Given these metabolic abnormalities, PCOS sufferers have a greatly increased risk of other, more serious, health problems, such as type 2 diabetes, hypertension and abnormal lipid levels, increasing the risk for heart disease. Because these women don't menstruate regularly, they may become infertile, and have a higher risk for uterine cancer.
Your skin symptoms are common in PCOS and are usually due to fungal or bacterial infection. Ringworm, also due to a fungus, tends to be more severe. This is because high blood sugar impairs immune resistance, and also damages the nerves that control sensation or pain that would otherwise alert you to a potential infection. Keeping your blood sugar as close to normal as possible will do much to reduce your risk of infections, and may help control your other symptoms, too.
Other options worth considering are:
* Lose weight - 60 per cent of PCOS suffers who lose weight can become pregnant without medical intervention (J Clin Endocrinol Metab, 1999; 84: 1470-4). Losing just 8 kg (18 lb) improves insulin sensitivity and lowers androgen levels as effectively as taking the Pill (J Clin Endocrinol Metab, 1999; 84: 2182-7). A high-protein, low-carbohydrate diet may prove more successful than a low-fat diet.
* Include more phytoestrogens in your diet, such as those in rhubarb, alfalfa, ginseng, fennel and celery. These help to regulate hormone levels with none of the health risks associated with synthetic oestrogens (J Alt Complement Med, 1993; 11: 13-6).
* Supplement with calcium and vitamin D, which can boost ovarian health and improve some of the symptoms of PCOS (Steroids, 1999; 64: 430-5). Check your vitamin D status before supplementing.
Taking 1.8-3 g/day of N-acetylcysteine (NAC) for six weeks restored normal insulin levels in nearly half the women taking it (Fertil Steril, 2002; 77: 1128-35).
D-Chiro-inositol is a natural carbohydrate found in fruit, vegetables and especially buckwheat. Taking 1200 mg/day lowered insulin and restored ovulation in 86 per cent of PCOS sufferers (N Engl J Med, 1999; 340: 1314-20). This also improved insulin, triglyceride and testosterone levels, and lowered blood pressure.
* Don't smoke. Smoking increases your risk of atherosclerosis (fatty deposits in the arteries), and also aggravates insulin resistance in type 2 diabetes (J Clin Endocrinol Metab, 1997; 82: 3619-24).
* Fight infections naturally. Conventional preparations can be toxic to humans, and some antifungals, such as imidazole, have never been adequately shown to work (J Fam Pract, 1994; 38: 601-4).
In contrast, tea tree (Melaleuca alternifolia) oil is a proven antifungal and antibacterial, and has a very low toxicity to humans. It works more slowly than conventional remedies, and you should continue to use it for two or three weeks after your symptoms have disappeared to make sure that you have completely cleared the infection.