Dr. Kali MacIsaac HBSc, ND

A very new study has shed some scientific light on what naturopathic doctors have known for a long time – skin health tells us a lot about the internal workings of the body, especially hormonal balance.

Many skin disorders are a manifestation of improper hormonal regulation

It is great when modern literature starts to align with what we know to be true: many skin disorders are a manifestation of improper hormonal regulation. For women with PCOS (polycystic ovarian syndrome), skin conditions such as acne, unwanted hair growth, and skin pigmentation changes are a daily struggle. This new literature suggests that the link between hormonal dysregulation in PCOS and skin conditions is not only valid, it’s predictive of the severity of the condition and future health outcomes.

Study links 2 skin conditions – hirsutism and acanthosis nigricans – to health outcomes in PCOS

The study,1 done at the University of California, San Francisco, linked two skin conditions – hirsutism (excessive hair growth in women) and acanthosis nigricans in the axillae (dark skin pigmentation under the arms) – to outcomes in PCOS. Women with PCOS often ovulate irregularly and have metabolic issues that can lead to long-term complications such as diabetes and heart disease. It is also often hard for women with PCOS to fall pregnant and take a healthy pregnancy to term.

A population of 401 racially diverse women with suspected PCOS were evaluated according to the Rotterdam criteria2 for PCOS diagnosis. Of the 68.8% of women who fit the criteria for diagnosis, approximately 92% had at least one skin finding.   This was statistically significant when compared to the women who didn’t fit the diagnostic criteria. One-quarter of women who had one of the skin manifestations of PCOS actually had both hirsutism and acanthosis nigricans.

Higher levels of insulin resistance found in women with both hirsutism and PCOS

On further evaluation, women with hirsutism who had PCOS had higher levels of insulin resistance compared to those non-PCOS women (4.18 vs 3.38, P = 0.002). They had higher body mass index (32.3 vs 29 kg/m2, P < 0.001), and higher triglyceride levels (114 vs 104 mg/dL, P = 0.04). PCOS women also showed lower levels of “good cholesterol,” HDL, at 52 vs 59 mg/dL for non-PCOS women (P < 0.001).

Women with Acanthosis nigricans and PCOS had increased prevalence of free testosterone elevations

When acanthosis nigricans was present in women with PCOS, they found significantly increased prevalence of free testosterone elevations (53.3% vs 27%, P < 0.001), higher measures of insulin resistance (7.13 vs 2.05, P < 0.001), higher BMI, higher total cholesterol, LDL and triglycerides, and lower HDL.

Interesting occurrence found in either skin manifestation and PCOS, including insulin regulation, higher BMI, and cardiovascular risks

So either skin manifestation, when present in women with PCOS, is indicative of poorer insulin regulation (a diabetes3 and heart disease4 risk factor), higher BMI (indication of potential obesity and its complications), and altered cholesterol levels (risks for cardiovascular5 complications).

In contrast, the presence of the skin conditions acne and androgenic alopecia (androgenic hormone-driven hair loss) were both deemed to be unreliable markers for PCOS.1

Women with PCOS who have either hirsutism or acanthosis nigricans should be screened very closely for metabolic conditions

The really important information that this study suggests is that women with PCOS who have either hirsutism or acanthosis nigricans should be screened very closely for metabolic conditions like insulin resistance, obesity, and hypercholesterolemia. Women with the skin conditions are at a higher risk of long-term health complications related to their metabolic issues.

While the researchers on this study suggest that referral to a dermatologist is a good idea for PCOS women, I would argue that treating the underlying inflammation and metabolic derangements of PCOS would be even more beneficial. As we always say in naturopathic medicine – tolle causam (treat the cause).

While there are many ways PCOS can present, consultation with an experienced naturopathic physician is important in order to address the major manifestations of PCOS that are present in your case. Balancing blood sugar, reducing inflammation, and helping to balance the hormonal system are keys to a naturopathic PCOS protocol.

DSC_0140 copyDr. Kali MacIsaac is the naturopathic physician providing functional medicine testing and integrative care at Acubalance Wellness Centre in Vancouver BC.

Kali is a registered Naturopathic Doctor (ND) with the College of Naturopathic Physicians of British Columbia.  She is a member of the BC Naturopathic Association (BCNA) and the Canadian Association of Naturopathic Doctors (CAND).  Prior to medical school, Kali earned an Honours Bachelor of Science degree in Biomedical Science from the University of Waterloo where her passion for healthcare developed.  Following this, she attended the Canadian College of Naturopathic Medicine (CCNM) in Toronto, Ontario, for a 4-year accredited naturopathic medicine program.

Dr. MacIsaac works as a general practitioner and has special interest in digestive health, reproductive health and fertility.  She has completed the full curriculum of Biological Medicine certification with the Paracelsus Klinik Lustmuhle, as instructed by Dr. Thomas Rau MD, as well as a full curriculum in microscope technology from BiomedX.  She believes in the power of an empowered patient and develops individual treatment protocols to inspire patients to take an active role in their health.

Dr. MacIsaac is also actively involved in educating the public about health and naturopathic medicine through speaking engagements and media appearances.


  1. Schmidt, T et al. Cutaneous findings and systemic associations in women with polycystic ovary syndrome. JAMA Dermatol 2015. Published online doi:10.1001/jamadermatol.2015.4498
  1. Boyle J and Teede H. Polycystic ovary syndrome: an update. RACGP 2012. 41(10):752-56.
  1. Chiu HK et al. Equivalent insulin resistance. Diabetes Res Clin Prac 2007. 77(2):237-44.
  1. Patel TP et al. Insulin resistance: an additional risk factor in the pathogenesis of cardiovascular disease in type 2 diabetes. Heart Fail Rev. 2015. Published online http://www.ncbi.nlm.nih.gov/pubmed/26542377
  1. Harv Heart Lett. The lesser known fat in your blood. Emerging evidence suggests that high triglycerides play a bigger role in heart disease than previously thought. 2014. 24(12):3.
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