Cutaneous Findings and Systemic Associations in Women With Polycystic Ovary Syndrome

Abstract

IMPORTANCE Understanding of the associations among cutaneous findings, systemic abnormalities, and fulfillment of the diagnostic criteria in women suspected of having polycystic ovary syndrome (PCOS) is incomplete. OBJECTIVE To identify cutaneous and systemic features of PCOS that help distinguish women who do and do not meet the diagnostic criteria. DESIGN, SETTING, AND PARTICIPANTS Retrospective cross-sectional study of a racially diverse referred sample of women seen at the University of California, San Francisco, Polycystic Ovary Syndrome Multidisciplinary Clinic over a 6-year period between May 18, 2006, and October 25, 2012. Participants were 401 women referred for suspected PCOS. In total, 68.8% (276 of 401) met the Rotterdam PCOS diagnostic criteria, while 12.0% (48 of 401) did not. Overall, 11.5% (46 of 401) had insufficient data to render a diagnosis, 1.7% (7 of 401) were excluded from the study, and 6.0% (24 of 401) refused to participate in the study. EXPOSURE Comprehensive skin examination and transvaginal ultrasonography. All patients were tested for levels of total testosterone, free testosterone, dehydroepiandrosterone (DHEAS), androstenedione, luteinizing hormone, and follicle-stimulating hormone. Levels of serum cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides were obtained, in addition to 0-hour and 2-hour oral glucose tolerance test (OGTT) results, with measurement of glucose and insulin levels.MAIN OUTCOMES AND MEASURES Findings from comprehensive skin examination, laboratory testing, and transvaginal ultrasonography. RESULTSIn total, 401 women with suspected PCOS were included in the study. The median patient age was 28 years. Compared with women who did not meet the diagnostic criteria for PCOS, women who met the criteria had higher rates of hirsutism (53.3% [144 of 270] vs 31.2% [15 of 48], P = .005) (with higher mean modified Ferriman-Gallwey scores of 8.6 vs 5.6, P = .001), acne (61.2% [164 of 268] vs 40.4% [19 of 47], P = .004), and acanthosis nigricans (AN) (36.9% [89 of 241] vs 20.0% [9 of 45], P = .03). Cutaneous distributions also varied. Women who met the PCOS criteria demonstrated more severe truncal hirsutism and higher rates of axillary AN. Women who met the PCOS criteria had elevated total testosterone levels (40.7% [105 of 258] vs 4.3% [2 of 47], P < .001). Among women with PCOS, the presence of hirsutism (43.9% [54 of 123] vs 30.9% [34 of 110], P = .04) or AN (53.3% [40 of 75] vs 27.0% [40 of 148], P < .001) was associated with higher rates of elevated free testosterone levels as well as several metabolic abnormalities, including insulin resistance, dyslipidemia, and increased body mass index. Although the prevalence of acne was increased among women with PCOS, there were minimal differences in acne types and distribution between the women meeting vs not meeting the PCOS criteria.CONCLUSIONS AND RELEVANCE Hirsutism and AN are the most reliable cutaneous markers of PCOS and require a comprehensive skin e...

Pattern of dermatologic manifestations in polycystic ovarian disease cases from a tertiary care hospital

“…5 Patients with PCOS are commonly first seen by a dermatologist. 6 Diagnosis is mainly clinical. Dermatologists often play a significant role in its management.…”

Effect of Diet Control Therapy on the Dermatological Symptoms of Obese Polycystic Ovarian Syndrome Women: Repeated Measure Design

“…In the current study, women followed the recommended macronutrient composition of weight-loss diets for obese PCOS women adopted by Moran et al [14], showed a significant weight reduction, acclaiming the benefits of that type of diet therapy. Weight reduction through diet control therapy, was adopted in the current study as obesity play a significant role in the pathology of PCOS [6], and though conservative treatment is recommended for PCOS through lifestyle modification [17], the term lifestyle modification is somehow vague. Lim et al [20], reported their disagreement with such hypothesis concerning the association between the lack of exercise and the clinical or biochemical characteristics typical of PCOS, supporting the concept of weight reduction in favor of exercise in the field of lifestyle modification.…”

“…Most women (91.7%) meeting the criteria for PCOS had at least one skin finding, with higher burden of acne, hirsutism, and acanthosis nigricans (AN) than women who did not meet the criteria [6]. In the present study, following the recommended diet for 12 weeks has significantly reduced acne and hirsutism scores and maintained that effect for another 12 weeks, which may be beneficial for improving all the other symptoms related to it, as beside all the previous mentioned symptoms, PCOS women may display several psychological disorders such as depression, anxiety, marital and social problems, which aggravate the psychological impact of hirsutism as, not only is hirsutism itself a major concern for women diagnosed with PCOS, but the time and effort spent eliminating it aggravates the distress [7], hence emerge the importance of measuring hirsutism because hirsutism score is the main predictor of psychological distress [34] and can significantly predict reduction of body hair, emotions, menstrual problems, weight and infertility problems, in their order of severity [7] Hirsutism was also associated with a higher mean HOMA-IR, body mass index, and triglycerides level, as well as a lower HDL-C level [6]. Although acne is not a reliable marker of hyperandrogenism, Androgens are important in the development of acne and its prevalence is high among patients who meet PCOS diagnosis [6].…”

“…PCOS is a heterogeneous disorder, characterized by menstrual irregularities or infertility, metabolic, and cutaneous disorders as clinical signs of excess androgen that include acne and Affecting between 2-7% [1] or 5-10 % [2] of reproductive-aged women, and with a prevalence rate of 20-30% among Caucasian women [3], Polycystic ovary syndrome (PCOS) is considered hirsutism [4]. In those women with PCOS, 92% shows cutaneous manifestations with hyperandrogenism associated signs [1,5] Hirsutism, a reliable cutaneous marker for hyperandrogenism [6], is a feminine condition of excessive terminal hair growth in an androgen-sensitive skin distribution [1], causing lack of self-confidence and a remarkable amount of emotional stress. As the sense of self-consciousness is originated from the concept "ideal hair pattern" known inside the patients' social and cultural environment [4].…”

Insulin sensitizing agent improves clinical pregnancy rate and insulin resistant parameters in polycystic ovarian syndrome patients with acanthosis nigricans: a randomized controlled study

“…AN is usually associated with obesity, insulin resistance and PSOS. 8 Hyperkeratosis is increased in melanin pigmentation resulting in the dark color of AN. 9 There is a subtle infiltrate composed of lymphocytes, plasma cells, and neutrophils as well as horn pseudocyst formation.…”