Polycystic ovary syndrome (PCOS) affects 8-13% of reproductive-age women globally and is the leading cause of androgen-driven dermatological disease in this population. Hyperandrogenism stimulates the pilosebaceous unit, producing hirsutism and acne vulgaris as the dominant clinical manifestations — quantified by the modified Ferriman-Gallwey scale and the Global Acne Grading System or Investigator Global Assessment scale respectively. First-line pharmacological treatments, including combined oral contraceptives and spironolactone, are contraindicated in women seeking conception and carry recognized adverse effect profiles. No network meta-analysis has synthesized botanical and nutraceutical agents against dermatological primary endpoints or benchmarked them against pharmacological standard of care within a unified evidence network. This review addresses that gap directly, producing the first ranked comparative hierarchy of interventions for hirsutism and acne in PCOS. Secondary endpoints include free androgen index, testosterone, SHBG, androstenedione and insulin resistance (HOMA-IR). Pharmacological agents are included as active network nodes, enabling direct comparisons not previously available in the literature.