Cutaneous Manifestations of Polycystic Ovary Syndrome: Endocrine–Metabolic Interactions and Comprehensive Therapeutic Strategies for Acne and Hirsutism

Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine and metabolic disorder frequently associated with dermatological manifestations that may precede the recognition of reproductive or metabolic abnormalities. Hyperandrogenism and insulin resistance play important roles in the development of acne, hirsutism, female pattern hair loss, and acanthosis nigricans, although their clinical expression varies according to peripheral androgen sensitivity, genetic susceptibility, and metabolic characteristics. This narrative review aimed to analyze the pathophysiological relationships between hormonal and metabolic disturbances and cutaneous manifestations of PCOS, emphasizing diagnostic considerations and comprehensive therapeutic strategies for acne and hirsutism. International clinical guidelines, systematic reviews, meta-analyses, and relevant clinical investigations were examined, incorporating evidence from Latin American populations. The reviewed findings indicate that hirsutism exhibits a more consistent association with biochemical hyperandrogenism, whereas acne involves additional inflammatory, follicular, and microbial mechanisms that limit its specificity as an indicator of androgen excess. Insulin resistance contributes to increased androgen bioavailability through compensatory hyperinsulinemia and reduced sex hormone-binding globulin concentrations, while acanthosis nigricans may indicate associated metabolic dysfunction. Therapeutic evidence demonstrates variable effectiveness among combined oral contraceptives, antiandrogenic medications, insulin-sensitizing agents, and conventional dermatological interventions, supporting individualized treatment selection according to clinical presentation, metabolic risk, and reproductive preferences. Differences in diagnostic criteria, study populations, and outcome assessment methods limit direct comparisons across investigations. The findings emphasize the importance of multidisciplinary collaboration and the adaptation of international recommendations to Latin American healthcare contexts. Overall, dermatological manifestations of PCOS should be approached as components of a systemic endocrine-metabolic disorder, requiring integrated assessment, personalized management, and further research involving diverse populations.