Skin deep: dermatologic challenges in PCOS through the female lifespan

INTRODUCTION: Polycystic ovary syndrome (PCOS) is a lifelong endocrine-metabolic condition with prominent dermatologic manifestations such as hirsutism, acne/seborrhea, and female pattern hair loss (FPHL), which are frequently the initial complaint for seeking medical attention. AREAS COVERED: This review explores the pathogenesis and dermatologic presentation of PCOS across the lifespan, emphasizing evidence-based diagnostic strategies, based on a PubMed literature search through August 2025. It also highlights the impact on quality of life, the need for psychosocial support, and the importance of cultural sensitivity in care. Management approaches are reviewed including pharmacologic therapies, procedures, and considerations across reproductive stages including pregnancy, postpartum, and menopause. Future directions in management are also discussed. EXPERT OPINION: Current care remains largely symptom-driven. A shift toward mechanism-based, personalized therapy is essential. Key priorities include biomarker-guided treatment, standardized assessment tools, cautious antibiotic use with microbiome-sparing approaches, and clinical trials targeting treatment-resistant/recurrent cases and FPHL. In the future, routine care should incorporate phenotype- and biomarker-based algorithms, artificial intelligence (AI)-assisted assessment, and integrated mental health support.