Skin manifestations of hyperandrogenism: an update

Skin manifestations of hyperandrogenism are common and clinically diverse findings, indicating the complex interplay between metabolic, endocrine, and dermatologic systems. The aim of this review was to collect and analyze data on skin manifestations of hyperandrogenism and review the current treatment options for these diseases.

We conducted a narrative review of the current literature focusing on cutaneous manifestations associated with hyperandrogenism. A search was performed on PubMed/MEDLINE which includes relevant articles published until February 2026. The search strategy included combinations of MeSH keywords ("hyperandrogenism," "polycystic ovary syndrome," "skin diseases," "hirsutism," "acne Vulgaris," "alopecia," "acanthosis nigricans," "acrochordons," and "hyperhidrosis") and screening of reference lists of selected articles. Eligible articles were considered those addressing epidemiology, pathophysiology, clinical presentation, diagnosis, and treatment of dermatologic manifestations associated with hyperandrogenism, with an emphasis on more recent bibliographic evidence.

The dermatologic spectrum of hyperandrogenism-induced manifestations primarily includes hirsutism, acne vulgaris, androgenetic alopecia, acanthosis nigricans, acrochordons, and hyperhidrosis. These cutaneous features are often the earliest clinical indicators of hyperandrogenism and are tightly associated with androgen receptor (AR) activation, local enzymatic conversion, and downstream metabolic and inflammatory pathways. Multiple therapeutic strategies were reviewed with an emphasis on hormonal agents which target AR in the skin.

Hyperandrogenism and the expression of AR in the skin precipitate the development of androgen-associated dermatologic conditions. Androgen-targeted treatment appears to be more effective when compared with other non-androgen-targeted therapeutic options. Further research is required to analyze the existing treatments and develop new approaches.