Title: Study of Cutaneous Manifestations of Polycystic Ovarian Syndrome

Authors: Dr Anupama Singh, MD, Prof R K P Chaudhary, MD

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i4.228

Abstract

Polycystic Ovary Syndrome (PCOS) is common in women of reproductive age group. The usual presentation is with irregular menstrual cycles, acne, hirsutism, alopecia and acanthosis nigricans. The aim was to study the various cutaneous manifestations in PCOS and to correlate these with selected hormonal levels. This study was conducted in 18 months, wherein 87 patients diagnosed as PCOS were included.

A detailed history and clinical examination was done for each patient, along with hormonal investigations like Thyroid Stimulating Hormone (TSH), Luteinizing Hormone (LH), Follicle Stimulating Hormone (FSH), Prolactin, Dehydroepiandrosterone sulphate (DHEAS), Sex Hormone Binding Globulin (SHBG) and total testosterone. Acne was the commonest finding (64.3%), followed by acanthosis nigricans (47.1%), hirsutism (41.4%) and alopecia (13.8%).

TSH and LH were raised in 6.8%. LH:FSH ratio was >2 in 8.5% patients. SHBG was decreased in 5.1%. Total testosterone was elevated in 18.6%. There was a significant correlation between LH and acne (p=0.036), the LH:FSH ratio and acne (p=0.047), and between LH and hair loss (p=0.027). Acanthosis nigricans was seen in 35.6% obese women (p=0.001).

Keywords:  Polycystic ovary, cutaneous , hyperandrogenism.

References

1.      Polycystic Ovarian Syndrome and Hyperandrogenism. In: Hoffmann BL, Schorge JO, Schaffer JI, Halvorson LM, Bradshaw KD, Cunnigham FG, editors. Williams Gynecology. Second Edition. The McGraw-Hill Companies, Inc. 2012; p. 460-80.

2.      Rotterdam ESHRE/ASRMSponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and longterm health risks related to polycystic ovary syndrome. Fertil Steril 2004;81:1925.

3.      Yildiz, B. O., Bolour, S., Woods, K., Moore, A., & Azziz, R. (2009). Visually scoring hirsutism. Human reproduction update, dmp024.

4.      Ramanand, S. J., Ghongane, B. B., Ram-anand, J. B., Patwardhan, M. H., Gha-nghas, R. R., & Jain, S. S. (2013). Clinical characteristics of polycystic ovary syndr-ome in Indian women. Indian journal of endocrinology and metabolism, 17(1), 138.

5.      Hayashi, N., Akamatsu, H., & Kawashima, M. (2008). Establishment of grading criteria for acne severity. The Journal of dermatology, 35(5), 255- 260.

6.      Singal, A., Sonthalia, S., & Verma, P. (2013). Female pattern hair loss. Indian Journal of Dermatology, Venereology, and Leprology, 79(5), 626.

7.      Kaliyadan, F., Nambiar, A., & Vijayaraghavan, S. (2013). Androgenetic alopecia: An update. Indian Journal of Dermatology, Venereology, and Leprology, 79(5), 613.

8.      Legro, R. S., Kunselman, A. R., Dodson, W. C., & Dunaif, A. (1999). Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women 1. The journal of clinical endocrinology & metabolism, 84(1), 165-169.

9.      Liou, T. H., Yang, J. H., Hsieh, C. H., Lee, C. Y., Hsu, C. S., & Hsu, M. I. (2009). Clinical and biochemical presentations of polycystic ovary syndrome among obese and nonobese women. Fertility and sterility, 92(6), 1960-1965.

10.  Gowri, B. V., Chandravathi, P. L., Sindhu, P. S., & Naidu, K. S. (2015). Correlation of skin changes with hormonal changes in polycystic ovarian syndrome: A cross-sectional study clinical study. Indian journal of dermatology, 60(4), 419.

11.  Olsen, E. A., Callender, V., McMichael, A., Sperling, L., Anstrom, K. J., Shapiro, J., ... & Bergfeld, W. (2011). Central hair loss in African American women: incidence and potential risk factors. Journal of the American Academy of Dermatology, 64(2), 245-252.

12.  Singla, R., Gupta, Y., Khemani, M., & Aggarwal, S. (2015). Thyroid disorders and polycystic ovary syndrome: An emerging relationship. Indian journal of endocrinology and metabolism, 19(1), 25.

13.  Fakhoury, H., Tamim, H., Ferwana, M., Siddiqui, I. A., Adham, M., & Tamimi, W. (2012). Age and BMI adjusted comparison of reproductive hormones in PCOS. Journal of family medicine and primary care, 1(2), 132.

14.  Borgia, F., Cannavo, S., Guarneri, F., Cannavo, S. P., Vaccaro, M., & Guarneri, B. (2004). Correlation between endocrine-logical parameters and acne severity in adult women. Acta Dermatovenereologica-Stockholm, 84(3), 201-204.

15.  Walton, S., Cunliffe, W. J., Keczkes, K., Early, A. S., McGarrigle, H. H. G., Katz, M., & Reese, R. A. (1995). Clinical, ultrasound and hormonal markers of androgenicity in acne vulgaris. British Journal of Dermatology, 133(2), 249-253.

Corresponding Author

Dr Anupama Singh, MD

Department of Skin and VD, Patna Medical College, Patna, Bihar, India