Androgen excess may also occur as part of hypothyroidism, porphyria and anorexia nervosa. The diagnostic investigation of each woman should be based on the most probable etiology determined from the history and a complete physical examination. Acne, hirsutism and alopecia may respond to spironolactone or antiandrogens such as cyproterone acetate. Other therapies include oral contraceptive pills to suppress androgen production by the ovaries and metformin to increase the insulin sensitivity that is common in polycystic ovary syndrome. Neck pain is common in adults and may result from multiple conditions.
Further investigations are of limited value in most cases.
Patient education stressing the remitting pattern of neck pain, avoidance of precipitants and exacerbating situations, and self-management, is essential. Pain control should be individualized. Morphea is a localized form of scleroderma characterized by indurated plaques with violaceous borders. The condition is three times more common in women than in men. Multiple or single lesions may be present, progressing slowly over months or years.