ArticlePDF Available

Polycystic ovarian syndrome in women with acne

Authors:

Abstract and Figures

Background Acne is a common manifestation of hyperandrogenemia. Polycystic ovarian syndrome (PCOS) is a common endocrine abnormality affecting reproductive aged women. In the female, the most common cause of hyperandrogenemia is PCOS. The purpose of our study was to determine the PCOS in women with acne. Patients and methods In this observational, cross sectional study, 40 females, aged 15-40 years, with various degree of acne who had not received hormonal treatment, including hormonal contraceptive and antiandrogen therapy, for at least 3 months prior to study and 30 female volunteers (aged 15-40 years) without acne or acne scars were enrolled as controls. The severity of acne was graded as mild, moderate or severe. Clinical data including age, weight, height, body mass index (BMI), menstrual history and androgenic sign (hirsutism, alopecia, acanthosis nigricans) were recorded and hormonal assays and pelvic ultrasonography were done. Clinical parameters (acne with menstrual irregularity) accompanied by other features of hyperandrogenism and/or elevated level of luteinizing hormone (LH ) to follicle-stimulating hormone (FSH) ratio and/or ultrasound picture based upon the presence of multiple small subcapsular cysts (diameter 2-8 mm) with dense echogenic stroma, were used to diagnose PCOS. Results 7.5% patients were obese in case group, which was statistically significant. No statistically significant differences were observed in hormonal profiles (serum LH and serum FSH) but significant differences seen in serum testosterone level and pelvic ultrasound to visualize the polycystic ovary in women with acne. There were 11 (27.5%) women with PCOS among the 40 women with acne; 8 showed PCO picture on ultrasound. 10 cases with elevated LH to FSH ratio. Out of 11 women with PCOS, 1 case was diagnosed only clinically. Control group had also one PCOS (3.3%). Prevalence of PCOS with acne was higher in studied cases than control group, which is statistically significant in our population. Conclusion All women with acne should be considered for underlying PCOS and asked about their menstrual patterns and examined for other sign of hyperandrogenism. Those who have menstrual disturbances should have hormonal profile determination as well as pelvic ultrasonography for ovarian visualization. Early diagnoses and treatment can avoid the possible complications.
Content may be subject to copyright.
Journal of Pakistan Association of Dermatologists 2012;22:24-29.
Address for correspondence
Dr.
Mst. Laila Anjuman Banu,
Professor, Genetic & Molecular Biology,
6
th
Floor, Basic Medical Sciences Building
Bangabandhu Sheikh Mujib Medical University,
Dhaka, Bangladesh
Ph# 01911344673
Email: dr.lailabanu@gmail.com
Original Article
Polycystic ovarian syndrome in women with
acne
Sayera Begum*, M Zakir Hossain**, Md. Fashiur Rahman†, Laila Anjuman Banu‡
*Department of Dermatology & Venereology, Central Police Hospital, Dhaka.
**Department of Dermatology & Venereology, Sir Salimullah Medical College, Dhaka.
†Department of Dermatology& Venereology, Mymensingh Medical College, Mymensingh
‡Department of Genetic & Molecular Biology, Bangabandhu Sheikh Mujib Medical University,
Dhaka
Abstract
Background Acne is a common manifestation of hyperandrogenemia. Polycystic ovarian syndrome
(PCOS) is a common endocrine abnormality affecting reproductive aged women. In the female, the
most common cause of hyperandrogenemia is PCOS. The purpose of our study was to determine the
PCOS in women with acne.
Patients and methods In this observational, cross sectional study, 40 females, aged 15-40 years,
with various degree of acne who had not received hormonal treatment, including hormonal
contraceptive and antiandrogen therapy, for at least 3 months prior to study and 30 female
volunteers (aged 15-40 years) without acne or acne scars were enrolled as controls. The severity of
acne was graded as mild, moderate or severe. Clinical data including age, weight, height, body mass
index (BMI), menstrual history and androgenic sign (hirsutism, alopecia, acanthosis nigricans) were
recorded and hormonal assays and pelvic ultrasonography were done. Clinical parameters (acne
with menstrual irregularity) accompanied by other features of hyperandrogenism and/or elevated
level of luteinizing hormone (LH ) to follicle-stimulating hormone (FSH) ratio and/or ultrasound
picture based upon the presence of multiple small subcapsular cysts (diameter 2-8 mm) with dense
echogenic stroma, were used to diagnose PCOS.
Results 7.5% patients were obese in case group, which was statistically significant. No statistically
significant differences were observed in hormonal profiles (serum LH and serum FSH) but
significant differences seen in serum testosterone level and pelvic ultrasound to visualize the
polycystic ovary in women with acne. There were 11 (27.5%) women with PCOS among the 40
women with acne; 8 showed PCO picture on ultrasound. 10 cases with elevated LH to FSH ratio.
Out of 11 women with PCOS, 1 case was diagnosed only clinically. Control group had also one
PCOS (3.3%). Prevalence of PCOS with acne was higher in studied cases than control group, which
is statistically significant in our population.
Conclusion All women with acne should be considered for underlying PCOS and asked about their
menstrual patterns and examined for other sign of hyperandrogenism. Those who have menstrual
disturbances should have hormonal profile determination as well as pelvic ultrasonography for
ovarian visualization. Early diagnoses and treatment can avoid the possible complications.
Key words
Acne, hyperandrogenemia, polycystic ovarian syndrome.
Introduction
Acne is a chronic inflammatory disease of
pilosebaceous units. Acne vulgaris remains
one of the most common conditions affecting
adolescents. The pathogenesis of acne is
multifactorial and complex.
1
There are four
major factors in etiology of acne are seborrhea,
Journal of Pakistan Association of Dermatologists 2012;22:24-29.
comedo formation, colonization of sebaceous
duct with Propionibacterium acnes and
inflammation. Seborrhea or increased
sebaceous gland activity, dependent on
androgenic sex hormone mainly of adrenal or
ovarian origin.
2
Classic acne vulgaris is usually gradual in
onset but an abrupt onset of acne should be
further questioned to explore an underlying
etiology. Hyperandrogenism should be
considered in the female acne patient whose
acne is severe, sudden in onset, or associated
with hirsutism or irregular menstrual periods.
In general laboratory workup is not indicated
unless hyperandrogenism is suspected.
3
An
appropriate, thorough history and physical
examination will identify evidence of
androgen excess. Laboratory screening for
hormonal abnormalities is imperative when
clinical signs of hyperandrogenism are
present.
4
Androgen levels in patients with acne
are higher than those in controls. Acne is a
clinical manifestation of some endocrine
diseases.
The polycystic ovary syndrome (PCOS) has
the highest prevalence in acne.
5
The PCOS is a
heterogeneous condition which is defined by
the presence of two out of the three criteria:
oligo- and/or anovulation, hyperandrogenism
(clinical and/or biochemical), polycystic
ovaries (with the exclusion of other etiology).
6
The pathogenesis of PCOS is unknown.
However it is a complex multigenetic disorder
characterized by abnormal gonadotropin
release and dysregulation of steroidogenesis. It
is a combination of genetic abnormalities
combined with environmental factor, such as
nutrition and body weight, which then affect
the expression of syndrome.
6
The clinical
definition of PCOS changed in recent years
and includes one of its cardinal criteria, the
dermatological manifestation of
hyperandrogenism chiefly acne vulgaris,
hirsutism, alopecia and acanthosis. Any one of
these dermatological features may provide
early clinical clues to recognition of PCOS. If
the condition is unrecognized or untreated, the
patient faces increased risk of reproductive,
metabolic, cardiovascular, psychological and
neoplastic squelae.
7
It is one of the most
common causes of anovulatory infertility.
8
Acne is a common manifestation of
hyperandrogenemia.
9
Therefore, acne may not
pose only cosmetic concern, but may also be
sign of underlying disease. In females, the
most common cause of hyperandrogenemia is
PCOS. Therefore, all women presenting with
acne should be considered for underlying
PCOS and asked about their menstrual pattern.
Those who have menstrual disturbance should
have hormonal profile, pelvic ultrasound
which will help early diagnosis of PCOS.
However, confirmation of diagnosis and
provision of detailed information to the
affected women together with the availability
of interdisciplinary treatment help to
improving PCOS-related symptoms and avoid
its possible consequences. It may help in the
better management of acne and to reduce their
psychological distress.
Patients and methods
This was a hospital-based, observational,
cross-sectional study which was carried out in
the out-patient Department of Dermatology
and Venereology of Dhaka Medical College
Hospital (DMCH), Dhaka from November
2007 to October 2008 over a period of 12
months. A total of 70 females, 40 female
patients with various degree of acne and 30
female volunteers without acne or acne scars
aged from 19-40 years were enrolled as
controls. Purposive sampling method was
done as per inclusion and exclusion criteria.
Inclusion criteria included: female acne
patients, aged 15-40 years who consented to
participate in the study and undergo pelvic
USG and blood tests; female acne patients
who had not received hormonal treatment,
Journal of Pakistan Association of Dermatologists 2012;22:24-29.
including hormonal contraceptives and
antiandrogen therapy for at least 3 months
prior to study; female acne patients with
menstrual irregularity; and obese female acne
patients. Patients with some co-existing
systemic illness or those who were on
hormonal, steroid or oral contraceptive therapy
were excluded from the study.
The severity of acne was graded as mild,
moderate or severe.
10
Clinical data, including
age, weight, height, body mass index (BMI),
menstrual history and androgenic signs were
recorded. Hormonal assays and pelvic
ultrasonography were done.
Operational terms and definitions
Acne
Acne is a chronic inflammatory disease of
pilosebaceous follicles characterized by
comedone, papules, pustules, nodules and
often scars.
11
Acne was graded as mild:
comedone, papules/pustules; moderate:
papules, pustules/nodules; and severe:
nodulocystic/acne conglobata (severe acne
with many abscesses, cysts, marked scarring
with sinus).
10
Body mass index (BMI)
The BMI was calculated as weight in
kilograms divided by the square of height in
meter; thin= BMI<18.5; normal range= BMI
18.5-24.9; overweight= BMI 25-29.9; obese=
BMI>30 (according to WHO classification).
Menstrual history
Menstrual factors such as cycle length
(minimum/ maximum), cycle irregularities, the
duration of menstrual bleeding or the absence
of bleeding without being pregnant were
examined.
Menstrual irregularity
Fewer than 9 periods a year or periods longer
than 40 days apart.
11
Ultrasound examination
Pelvic USG were performed in all subjects
either transabdominally or transvaginally (in
married women). Either a 3.5 MHz
transabdominal (full bladder technique) or a 5
MHz transvaginal probe was used. The
ovarian morphology was carefully visualized.
Polycystic ovary (PCO) diagnosis was based
upon the presence of multiple small
subcapsular cysts (diameter 2-8 mm) with
dense echogenic stroma. PCO was not
diagnosed in cases with multiple small cysts
scattered throughout the ovary without dense
echogenic cores.
Hormonal assays
Blood samples were drawn from all subjects
for estimation of serum concentration of
testosterone, luteinizing hormone (LH) and
follicle-stimulating hormone (FSH). Sera were
frozen at -20ºC until the time of assay.
Measurements of the hormones were
performed by radioimmunoassay.
Polycystic ovarian syndrome (PCOS)
The PCOS is a heterogeneous condition which
is defined by the presence of two out of the
following three criteria: i) Oligo- and/or
anovulation;
ii) h
yperandrogenism (clinically
or biochemically); and
iii) p
olycystic ovary,
with exclusion of other etiology.
6
Diagnostic criteria for PCOS
The diagnostic criteria for PCOS was acne
with menstrual disturbances accompanied by a
clinical feature of hyperandrogenism/ratio of
LH to FSH equal to or greater than 2 and/or
and by ultrasonic findings of PCO.
9
Data analysis
Descriptive statistics were calculated,
including mean, standard deviation (SD). The
chi-square test and unpaired t-test were used to
determine the statistical significance. P values
less than 0.05 were considered statistically
significant. All statistical calculations were
Journal of Pakistan Association of Dermatologists 2012;22:24-29.
done by computer using the program SPSS
(Statistical Package for the Social Sciences)
version 11.0.
Results
The study included 70 subjects out of which
40 (57.1%) were in case and 30 (42.9%) were
in control group No statistical significant
(p>0.05) difference was found in menstrual
history between case and control in chi square
test (Table 1). Obesity was found only in case
group, in which 3 (7.5%) patients were obese
(Table 1), p<0.05. In USG, polycystic ovary
was found in 20.0% and 3.3% in cases and
controls, respectively (p<0.05), Table 1. The
mean levels of LH and FSH were not different
in two groups, however, serum testosterone
levels were significantly lower in controls
(p=0.001), Table 2.
There were 11 females with PCOS among the
40 patients with acne (case group) and 1
(3.3%) PCOS case amongst 30 controls (Table
3), (p<0.05). Out of 11 PCOS patients in case
group, 8 were diagnosed PCOS by acne (A) +
menstrual irregularities (MI) + PCO on
ultrasound + LH:FSH (>2:1), 2 cases by
A+MI+LH:FSH with hyperandrogenism
(hirsutism, alopecia, acanthosis nigricans) and
1 case diagnosed by A+MI+
hyperandrogenism.
Table 3 compares different characteristics in
PCOS cases in two groups. The mean BMI
and S. testosterone were statistically
significant (p<0.05) in chi square, however
others were not statistically significant
(p>0.05).
Discussion
In this study, prevalence of PCOS in acne
patients was 27.5%, which was significant.
PCOS is a common endocrine disorder. Its
etiology remains uncertain, and the diagnostic
Table 1 Menstrual history of the study population
(n=70).
Case
(n=40) Control
(n=30)
N (%) N (%)
Menstrual history
Irregular 12 (30) 13 (43.3)
NS
Regular 28 (70) 17 (56.7)
NS
Body mass index
Normal 18 (45.0) 16 (53.3)
NS
Overweight 19 (47.5) 14 (46.7)
NS
Obese 3 (7.5) 0 (0.0)
S
USG of uterus with adnexal
Polycystic ovary 8 (20.0) 1 (3.3)
S
Normal ovary 32 (80.0) 29 (96.7)
NS
NS=not significant (p>0.05), S=significant
(p<0.05).
Table 2 Mean distribution of biochemical
parameters of the study population (n=70).
Biochemical
parameters
Case
(n=40) Control
(n=30)
Mean±SD Mean±SD
LH (nmol/l) 13.4 ±13.0 11.3±9.2
NS
(2.72-83.77) (1.75-42.68)
FSH (nmol/l) 8.9±6.4 8.9±5.9
NS
(1.26-30.06) (1.89-26.6)
Serum testosterone 81.0±38.0 46.7±25.3
S
(nmol/l) (3.2-183) (0.20-106.2)
NS=not significant (p>0.05), S=significant (p <
0.05) with unpaired t test.
FSH=serum follicle-stimulating hormone,
LH=serum luteinizing hormone.
Table 5 Characteristics in PCOS patients in case
and control groups.
Mean values Cases
(n=11) Controls
(n=1)
Age (years) 21.5±4.8 24.7±5.9
Weight (kg) 63.0±8.8 58.2±6.5
BMI (kg/m
2
) 27.5±3.6 24.4±3.1
S
LH (nmol/l) 15.8±7.0 12.5±14.7
FSH (nmol/l) 7.8±3.0 9.3±7.3
Testosterone (nmol/l) 115.5±7.3 67.5±30.3
S
S=significant (p < 0.05), BMI=body mass index,
FSH=serum follicle-stimulating hormone,
LH=serum luteinizing hormone.
criteria are still debated. This syndrome has a
wide spectrum of clinical, biochemical and
ovarian morphological features.
9
The clinical
definition of PCOS has changed in recent
years and includes as one of its cardinal
criteria the dermatological manifestation of
hyperandrogenism, chiefly acne vulgaris,
Journal of Pakistan Association of Dermatologists 2012;22:24-29.
hirsutism and androgenic alopecia.
7
In this
study, the mean age of respondent was
23.8±5.7 years. The result of the observation
was similar with the study done in Italy,
12
where mean age of respondents were
23.6±6.06 years.
12
In our study, 47.5% patients
were overweight and 7.5% acne patients were
obese according to WHO criteria. The mean
BMI status of PCOS with acne was 27.5±3.6
kg/m² and without PCOS was 24±3.1 kg/m².
BMI status in PCOS with acne was
significantly higher than acne without PCOS
in our study. This finding was similar with the
previous data.
9
Patient with PCOS typically
have menstrual disorder, obesity, hirsutism
and often acne. This study found that almost
30% female acne patient had menstrual
irregularities. 40% female acne patient had
also menstrual irregularity in previous study.
9
While assessing an individual patient of acne,
a detailed history of menstrual disorder
especially oilgo- and amenorrhea is
mandatory.
13
Hirsutism and alopecia may also
be seen in women with acne due to
hyperandrogenemia.
13
No statistically
significant differences were observed in
hormonal profiles (serum LH and FSH)
between case and control groups in our study.
However, serum testosterone level
significantly tends to be higher in patient with
PCOS with acne. The limitations of the
hormone assays are also due to differences and
variation in the assay techniques. Even in
typical PCOS cases, the LH to FSH ratio
might not be higher than usual.
9
In the present
study, the LH to FSH ratio was also not higher
in PCOS cases. These are consistent with the
results by Timpatanapong and Rojanasakul
study.
9
PCO was visualized by ultrasonography in
about 20% of case group and 3.3% of control
group in our study, which was significant.
However, Timpatanapong and Rojanasakul
found PCO only in cases, not in control
group.
9
There is substantial heterogeneity of
symptoms and signs among women with
PCOS. In addition to different diagnostic
criteria used, the ethnic background of women
with PCOS may affect the clinical and
hormonal condition.
14
Clinical parameters (acne with menstrual
irregularity) accompanied by other features of
hyperandrogenism (hirsutism/acanthosis
nigricans/alopecia) with or without elevated
level of LH to FSH ratio (equal to or greater
than 2) and/or ultrasound picture were used in
this study to diagnose PCOS. PCOS found
higher in case (n=11) than control group (n=1)
among the study subjects. However, the
prevalence of PCOS in women with acne in
our study is lower than other studies. Other
researcher found 37.3% and 45.37% acne
patient had PCOS in their studies,
9,12
except for
the a study
15
which found that only 19% acne
patient had PCOS.
We conclude that all female patients with acne
should be screened for PCOS by history and
examination and if necessary, pelvic
ultrasound and hormonal assays should be
done.
References
1. Tom WL, Barrio VR. New insight
into adolescent acne. Curr Opin
Pediatr 2008;20:436-40.
2. Simpson NB, Cunliffe WJ. Disorder
of the sebaceous glands. In: Burns T,
Breathnach S, Cox N, Griffiths C,
editors. Rook's Textbook of
Dermatology. 7
th
ed. London:
Blackwell Science; 2004. P 43.1-
43.74.
3. .Kalus AA, Chien AJ, Olerud JE.
Diabetic mellitus and other endocrine
diseases. In: Wolff K, Goldsmith LA,
Katz SI et al., editors. Fitzpatrck's
Dermatology in General Medicine. 7
th
ed. New York: McGraw-Hill; 2008.
P. 1462-1482.
4. Harper JC. Evaluating
hyperandrogenism: a challenge in
acne management. J Drugs Dermatol
2008;7:527-30.
Journal of Pakistan Association of Dermatologists 2012;22:24-29.
5. Dekkers OM, Thio BH, Romijn JA,
Smit JW. Acne vulgaris endocrine
aspect. Ned Tijdschr Geneesked
2006;150:220-30.
6. Balen AH. Polycystic ovary
syndrome and secondary
amenorrhoea. In: Edmonds DK,
editor. Dewhurt's Textbook of
Obstetrics & Gynaecology. 7
th
ed.
USA: Blackwell; 2007. P. 377-97.
7. Lee AT, Zane AT. Dermatological
manifestations of polycystic ovary
syndrome. Am J Clin Dermatol
2007;8:201-19.
8. Allahabadia GN, Merchant R.
Polycystic ovarian syndrome in the
Indian Subcontinent. Semin Reprod
Med 2008;26:22-34.
9. Timpatanapong P, Rojanasakul A.
Hormonal profiles and prevalence of
polycystic ovary syndrome in women
with acne. J Dermatol 1997;24:223-9.
10. Zaenglien AL, Graber EM, Thiboutet
DM, Strauss JS. Acne vulgaris and
acne form eruptions. In: Wolff K,
Goldsmith LA, Katz SI et al., editors.
Fitzpatrck's Dermatology in General
Medicine. 7
th
ed. USA: McGraw Hill;
2008. P.. 690-730.
11. James WD, Berger TG, Elston DM,
editors. Andrew's Disease of the Skin.
10
th
ed. Philadelphia: Saunders
Company; 2006.
12. Fraser IS, Kovacs G. Current
recommendations for the diagnostic
evaluation and follow-up of patients
presenting with symptomatic
polycystic ovary syndrome. Best
Pract Res Clin Obstet Gynaecol
2004;18:813-23.
13. Prediction of increased levels of
androgen in women with acne
vulgaris using ultrasound and clinical
parameters. Ceska Gynekol 64:242-6.
14. Yu NE, Ho PC. Polycystic ovary
syndrome in Asian women. Semin
Reprod Med 2008;26:14-21.
15. Borgia F, Cannavò S, Guarneri F et
al. Correlation between
endocrinolgical parameters and acne
severity in adult women. Acta Derm
Venereol 2004;84:201-4.
... Although the most control women with the same age. This result accepted with (Begum, S., 2012) [9] Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting women of childbearing age. ...
... As was seen by (Deswal, R., et al. 2020) [10] who reported the increased skin sebum secretion or acne with polycystic ovary women. Also agreed with (Begum, S., 2012; Hacivelioglu, S., et al. 2013) [9,13] He wrote that acne is a common manifestation of hyperandrogenism and androgen excess in patients with (PCOS). This is consistent with (Wolkenstein P. et al., 2018) [31] , who also observed that menstrual cycle disorders and androgen excess are associated with acne, hirsutism, and high levels of LH and testosterone. ...
... Most symptoms increased during exams. In a study conducted at Dhaka Medical College Hospital (DMCH), researchers discovered that out of 40 women with acne, 11 (27.5%) were diagnosed with PCOS, eight (20%) exhibited PCOS features on ultrasound, and 10 women had an elevated LH to FSH ratio [16]. Furthermore, 36 students (14.9%) in our study suffer from blackish marks on the neck. ...
... (1) Polycystic ovary syndrome is characterized by chronic anovulation, hyperandrogenism, and multiple small subscapular cystic follicles in the ovary on ultrasonography. (2) Chemerin is a new adipokine of 163 amino acids and a of a molecular weight of 14 kDa (3) Chemerin has been identified as a novel discovered adipocytokine that has been shown to regulate adipocyte differentiation, modulation the expression of adipocyte genes. (4) Chemerin is found to be highly expressed in adipose tissue and the liver, as well as by cells of the innate immune system, where it modulates the function of innate immune cells. ...
Article
Full-text available
Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women ofreproductive age, affecting 6%–10% of women worldwide. Objective: The study aimed to assess the relationof serum chemerin level with lipid profile in women with polycystic ovarian syndrome.Materials and Method: A cross?sectional study was carried out in Salah Al-din City from 10th of October2019, to 20th of December 2019. The number of polycystic ovary syndrome women under study was 60women whose ages were between 15 and 36 years old. These women admitted to obstetrics and gynecologyunit at Salah Al-din Teaching Hospital. The control group who were matched to the patients studied included30 women.Results: The study showed that there is the significant difference between PCOS women and the controlgroup concerning serum chemerin level and lipid profile in PCOS women. This study demonstrates thatthere was a weak positive correlation between levels of chemerin and cholesterol in PCOS women (r =0.02) which is mean that cholesterol level is slightly increased with the elevation of chemerin hormone inwomen with PCOS, There was a positive correlation between levels of chemerin and Triglyceride in PCOSwomen (r = 0.16) which is mean that level is slightly Triglyceride increased with the elevation of chemerinhormone in women with PCOS, There was a positive correlation between serum levels of chemerin andVLDL in PCOS women, slightly VLDL increased with the elevation of chemerin hormone in women withPCOS. There was a positive correlation between levels of chemerin and LDL in PCOS women, slightlyLDL increased with elevation of chemerin hormone in women with PCOS. This study showed negativecorrelation between Chemerin and, HDL in PCOS women, slightly HDL decreased with the elevation ofchemerin hormone in women with PCOS.Conclusion: Highly significant relation of Chemerin and Cholesterol,Triglyceride,LDLandVLDL inPCOS,While negative correlation between Chemerin and HDL
... Estos datos fueron mayores que en el estudio iraquí. En cuanto al sobrepeso y la obesidad, fueron del 20,12% y 5,92%, respectivamente, datos que son inferiores a los informados en los estudios de Begums y colaboradores y de Moran y colaboradores (24,25) . Además, contrasta la prevalencia de exceso de peso encontrada en nuestra investigación con la reportada por la Encuesta Nacional de Situación Nutricional 2015 (ENSIN 2015), donde se reportó una prevalencia de sobrepeso y obesidad en mujeres colombianas del 37,2% y 22,4% (26) . ...
Article
Full-text available
Introducción: El acné de la mujer adulta (AMA) es una enfermedad inflamatoria del folículo pilosebáceo que se presenta después de los 25 años, su prevalencia ha aumentado en los últimos años y se ha asociado a enfermedades endocrinas como el síndrome de ovario poliquístico (SOP). El objetivo es determinar la prevalencia del SOP clínico y bioquímico en mujeres colombianas con acné en la edad adulta en el servicio de dermatología y endocrinología. Materiales y métodos: Estudio observacional descriptivo de corte transversal. Se incluyeron mujeres atendidas en la consulta de dermatología y endocrinología en 2 clínicas privadas de Bucaramanga, Santander durante el 2021. Los datos demográficos, clínicos, de laboratorio y diagnóstico se recopilaron mediante historias clínicas electrónicas y aquellas que asistieron a consulta externa. Resultados: Se incluyeron 169 mujeres con acné con edad promedio 32,14 ± 5,62 años. El 44,97% presentó por primera vez acné después de los 25 años, el 34,91% persistió desde la adolescencia y el 20,11% restante reapareció. El 86,39% presentó acné inflamatorio, con preferencia en cara, seguido de espalda y tórax anterior. La severidad del acné fue leve en el 53,90%. La prevalencia del SOP fue del 62,13%, donde predominó el fenotipo A. Conclusiones: el Acné de la mujer adulta es un marcador de hiperandrogenismo, siendo el SOP la causa más frecuente (6 de cada 10). Por lo tanto, se sugiere el estudio sistemático de SOP en mujeres adultas que consultan por acné.
... Much higher prevalence has been reported in other studies. Begum et al. 29 found overweight in 47.5% and obesity in 7.5% as per WHO criteria. Tanghetti 16 found overweight or obesity in 51.9% in adult age group (>25 years) in contrast to 30% found by us. ...
... Our study also found that the prevalence of acne was more prevalent in women with PCOS than in controls, which is consistent with a study by Begum et al., (18) that found a higher frequency and proportion of acne in women with PCOS compared to normal women. ...
Article
Full-text available
Introduction and Aim: Polycystic ovarian syndrome (PCOS) is characterized by chronic anovulation and hyperandrogenism. PCOS also affects thyroid hormones, with multiple studies showing a link between autoimmune thyroid disease (AITD) and polycystic ovarian syndrome, although the exact pathophysiology of this interaction remains unknown. In this study the autoimmune thyroid indicators in women with PCOS were examined in order to demonstrate a link between polycystic ovarian syndrome and autoimmune thyroid disease. Materials and Methods: The study included 85 polycystic ovarian syndrome (PCOS) patients and 50 controls with similar ages. Thyroid autoantibodies (anti-thyroglobulin (Anti-Tg) and anti-peroxidase (anti-TPO), thyroid hormones (free thyroxine (T4), triiodothyronine (T3), and thyroid stimulating hormone (TSH), follicle stimulating hormone (FSH), and luteinizing hormone (LH) were determined in both study groups of women. Results: In women with polycystic ovarian syndrome (PCOS) the blood levels of anti-thyroid peroxidase antibody (anti-TPO), antithyroglobulin antibody (anti-TG)) and thyroid stimulating hormone (TSH) were higher than women without PCOS. However, no difference was observed for free thyroxine (FT4) levels among PCOS and no PCOS women. Conclusion: Thyroid dysfunction and thyroid autoimmunity was found to be linked in women with PCOS.
... Polycystic ovary syndrome (PCOS) is considered as one of the most common endocrine defect in reproductive aged women, impacting 6%-10% of female globally [1]. PCOS is characterized by hyperandrogenism, chronic anovulation and multiple small subscapular cystic follicles in the ovary by Ultrasonography [2]. The diagnosis of PCOS is based on the prescence of at least two criteria of the following: enlarged ovaries comprising over 12 follicles, irregular or absent ovulation and increased androgenic hormones [3]. ...
Article
Full-text available
The common endocrine disorder in women is that Polycystic ovarian syndrome (PCOS) specially in reproductive age. The study included 60 women suffer from the PCOS attending the obstetrics and gynecology unit in Kirkuk General Hospital, ages ranged from 18 to 42 years old. Also, the study included 30 non PCOS women as a control group. To assess the effect of Vitamin D in women suffering from polycystic ovarian syndrome. Serum Vitamin D was evaluated using Enzyme linked immunosorbent assay (ELISA) technique. The study reported that 58.3% of PCOS women enrolled in this study were within the age group 16- 25year. The study reported that the BMI of PCOS women was (mean 30.98 ± 4.02) Kg/cm2, whereas (22.77±2.52) Kg/cm2 of the control group (P: 0.0004). A significant difference recorded in the study in the Vitamin D levels in Polycystic overian syndrom women compared to the healthy group (mean 18.69±5.11 25.99±5.70).
... Polycystic ovary syndrome (PCOS) is considered as one of the most common endocrine defect in reproductive aged women, impacting 6%-10% of female globally [1]. PCOS is characterized by hyperandrogenism, chronic anovulation and multiple small subscapular cystic follicles in the ovary by Ultrasonography [2]. The diagnosis of PCOS is based on the prescence of at least two criteria of the following: enlarged ovaries comprising over 12 follicles, irregular or absent ovulation and increased androgenic hormones [3]. ...
Article
Full-text available
The common endocrine disorder in women is that Polycystic ovarian syndrome (PCOS) specially in reproductive age. The study included 60 women suffer from the PCOS attending the obstetrics and gynecology unit in Kirkuk General Hospital, ages ranged from 18 to 42 years old. Also, the study included 30 non PCOS women as a control group. To assess the effect of Vitamin D in women suffering from polycystic ovarian syndrome. Serum Vitamin D was evaluated using Enzyme linked immunosorbent assay (ELISA) technique. The study reported that 58.3% of PCOS women enrolled in this study were within the age group 16- 25 year. The study reported that the BMI of PCOS women was (mean 30.98 ± 4.02) Kg/cm2, whereas (22.77±2.52) Kg/cm2 of the control group (P: 0.0004). A significant difference recorded in the study in the Vitamin D levels in Polycystic overian syndrom women compared to the healthy group (mean 18.69±5.11 25.99±5.70).
... Eight studies searched for the prevalence of PCOS in the country; all but one study was single centered [ Table 1]. [9][10][11][12][13][14][15][16] Most of these studies were conducted among infertile women; one was conducted among hirsute women, and another among those presented with acne. Three studies used revised Rotterdam criteria for PCOS diagnosis, while the other five did not mention the diagnostic criteria used. ...
Article
Full-text available
Polycystic ovary syndrome (PCOS) is the most common endocrinopathy affecting reproductive‑aged women. PCOS is not a homogeneous disease and can manifest as a range of multifaceted problems, including various reproductive, cosmetic, cardiometabolic, and psychiatric conditions. In Bangladesh, research defining the prevalence and characteristics of PCOS is not ample. This review summarizes the findings from published studies that provide consistent evidence on the prevalence and characteristics of women with PCOS in the country. The small‑scale studies conducted among different subgroups of women indicate a high prevalence of the condition. Clinical presentations of PCOS in Bangladeshi women are also highly variable. A substantial portion has obesity, insulin resistance, abnormal glucose tolerance, dyslipidemia, and metabolic syndrome, which significantly threaten their cardiovascular health. Many of them have co‑existent other endocrinopathies, including thyroid abnormalities. Moreover, highly prevalent psychiatric comorbidities among these women warrant routine screening for these conditions.
... The normoandrogenic phenotype has a weak association with insulin resistance and metabolic comorbidities (19,25). Due to the endocrine, reproductive, cardiovascular and oncological complications that may occur, it is important that adult women presenting with acne to the dermatologist should be investigated to exclude PCOS (27). ...
Article
Full-text available
Acne is a chronic inflammatory condition affecting the pilosebaceous unit that was traditionally viewed as a disease of the adolescence. However, over the past several years, an increasing number of adult women have been reported to suffer from this condition. The prevalence of adult female acne ranges between 12 and 54%. Two clinical types can be distinguished in this population, a 'retentional' and an 'inflammatory' type, which usually tend to overlap. In terms of evolution, three main subtypes can be identified: Persistent acne, which is the most frequent subtype, late-onset acne and recurrent acne. This type of acne is mainly mild-to-moderate in severity and may be refractory to conventional treatment. The etiopathogenesis is complex and has yet to be fully elucidated. It appears to involve an interaction among genetic predisposition, hormonal factors, and chronic activation of the innate immune system overlapping with external factors, such as daily stress, Western-type diet, use of tobacco and cosmetics. The treatment may be challenging and a holistic approach is required, with special attention to the individual needs and particularities of adult women. Both topical and systemic treatments are available, with hormonal therapies being of special value in this population. The aim of the present article was to provide up-to-date, evidence-based information on the clinical presentation, etiopathogenesis and treatment of adult female acne.
Article
Full-text available
Many studies demonstrate increased androgen levels and high prevalence of polycystic ovaries in women affected by acne. We evaluated the relationship between clinical features, ultrasonographic data on polycystic ovaries and hormonal parameters in 129 women >17 years of age with acne. Serum levels of androgens of ovarian and adrenal origin were measured. Menstrual cycle regularity, hirsutism, body mass index and ultrasonographic evaluation of ovaries were recorded. Raised levels of at least one androgen were evident in a majority of our patients. Only 19% of them had polycystic ovary syndrome. Hirsutism and acne severity correlated negatively with serum sex hormone-binding globulin (SHBG) levels (p<0.05). No correlation between acne severity and hirsutism was found. In post-pubertal women, severity of acne seems to depend on peripheral hyperandrogenism, with a negative relationship between the acne severity and serum SHBG levels. We strongly recommend the evaluation of serum SHBG levels in women with acne in order to select patients who can have a better response to appropriate hormonal regimes.
Article
Full-text available
Polycystic ovary syndrome (PCOS) affects 5-10% of reproductive-aged women and is one of the most common endocrine disorders in women. The disorder is commonly characterized by elevated levels of androgen and insulin. Women with PCOS may present with a range of signs and symptoms, and face increased risks of reproductive, metabolic, cardiovascular, psychologic, and neoplastic sequelae, particularly if the condition is left unrecognized or untreated. The clinical definition of PCOS has changed in recent years and includes as one of its cardinal criteria the dermatologic manifestations of hyperandrogenism, chiefly hirsutism, acne vulgaris, and androgenetic alopecia. Acanthosis nigricans, a cutaneous sign of hyperinsulinemia, may also be present. These dermatologic features may provide early clinical clues to recognition of PCOS, and treatment of these cutaneous conditions may improve the patient's quality of life and psychologic well-being. The effects of androgen on pilosebaceous units in the skin can vary by anatomic location, producing pathophysiologic effects on hair growth and differentiation, sebaceous gland size and activity, and follicular keratinization. Treatment modalities may include hormonal therapy intended to modulate androgen production and action as well as non-hormonal therapies directed toward specific dermatologic conditions.
Article
One of the important etiologic factors in acne is an increase in sebaceous gland activity, which is androgen dependent. Acne is a common manifestation of hyperandrogenemia. Therefore, acne may not only cause cosmetic concern but may also be a sign of underlying disease. In females, the most common cause of hyperandrogenemia is polycystic ovary syndrome (PCOS). The purpose of this study was to determine the hormonal profiles of women with acne and the prevalence of PCOS in women attending the dermatological clinic with acne problems. The diagnostic criteria of PCOS were clinical findings of menstrual disturbances and hyperandrogenism (acne, seborrhea, hirsutism), pelvic ultrasound imaging of PCO (multiple subcapsular ovarian cysts 2–8 mm. in diameter, with dense echogenic stroma), and an elevated luteinizing hormone (LH) to follicle stimulating hormone (FSH) ratio. There were 51 women with acne; 20 regularly menstruating volunteers without acne served as a control group. PCOS was found in 19 out of 51 patients with acne (37.3%) and none of the control group. Twenty acne patients had abnormal menstruation (39.2%). Acne cases had higher mean levels of serum total testosterone (T), free T, dehydroepiandrosterone sulfate (DHEAS) and prolactin (PRL). No statistically significant difference was observed for LH, FSH or sex hormone binding globulin (SHBG). Because of this high prevalence of PCOS in women with acne, all women presenting with acne should be asked about their menstrual pattern and examined for other signs of hyperandrogenemia. Hormonal profile determination as well as pelvic ultrasonography for ovarian visualization should be performed to confirm the diagnosis of PCOS in female acne patients who have menstrual disturbances.
Article
Recent international agreement on the definitions of polycystic ovary syndrome (PCOS) has helped to clarify the clinical approach to diagnosis of PCOS. However, in the precise assessment of an individual patient it is still necessary for a detailed history of menstrual disorder (especially oligo- and amenorrhoea and anovulatory dysfunctional uterine bleeding), infertility or miscarriage, hyperandrogenism (mainly acne, hirsutism and scalp hair loss, distinguished from virilization) and obesity supplemented by the demonstration of polycystic ovaries on transvaginal ultrasound scanning. Assessment of endocrine changes in serum levels of luteinizing hormone, follicle stimulating hormone, oestradiol and prolactin, plus appropriate measures of circulating androgens (especially total and free testosterone, sex hormone binding globulin, 17 hydroxy-progesterone, dehydro-epiandrosterone sulphate and sometimes a 24-hour urinary free control) might help in further defining the abnormalities. Assessment of ovulatory status, obesity (body mass index and waist-hip ratio) and insulin resistance (oral glucose tolerance test with serum insulin levels) are also important in most cases. PCOS is a highly variable condition and investigation and management needs to be individualized. Long-term follow-up is also to a great extent dictated by the constellation of symptoms and clinical features of individual patients, but potential long-term hazards should be defined and patients warned of these.
Article
Androgens play an important part in the development of acne vulgaris. Androgen levels in patients with acne are higher than those in controls and people with the androgen insensitivity syndrome do not develop acne. Local factors other than androgen plasma levels, also play a part in the development of acne. The skin contains enzymes that convert precursor hormones to the more potent androgens such as testosterone and dihydrotestosterone. Androgen synthesis can therefore be regulated locally. The effects of androgens on the skin are the result of circulating androgens and enzyme activity in local tissues and androgen receptors. Acne is a clinical manifestation of some endocrine diseases. The polycystic ovary syndrome has the highest prevalence. In women with acne that persists after puberty, in 10-200% of cases polycystic ovary syndrome is later diagnosed. The mechanism of hormonal anti-acne therapy may work by blocking the androgen-production (oestrogens) or by blocking the androgen receptor (cyproterone, spironolactone).
Article
Polycystic ovary syndrome (PCOS) is a complex, multifaceted, heterogeneous disorder that affects ~5 to 10% of women of reproductive age. It is characterized by hyperandrogenism, polycystic ovaries, and chronic anovulation along with insulin resistance, hyperinsulinemia, abdominal obesity, hypertension, and dyslipidemia as frequent metabolic traits (metabolic syndrome) that culminate in serious long-term consequences such as type 2 diabetes mellitus, endometrial hyperplasia, and coronary artery disease. It is one of the most common causes of anovulatory infertility. However, the heterogeneous clinical features of PCOS may change throughout the life span, starting from adolescence to postmenopausal age, largely influenced by obesity and metabolic alterations, and the phenotype of women with PCOS is variable, depending on the ethnic background. The etiology of PCOS is yet to be elucidated; however, it is believed that in utero fetal programming may have a significant role in the development of PCOS phenotype in adult life. Though a woman may be genetically predisposed to developing PCOS, it is only the interaction of environmental factors (obesity) with the genetic factors that results in the characteristic metabolic and menstrual disturbances and the final expression of the PCOS phenotype. Irrespective of geographic locations, a rapidly increasing prevalence of polycystic ovarian insulin resistance syndrome, excess body fat, adverse body fat patterning, hypertriglyceridemia, and obesity-related disease, such as diabetes and cardiovascular disease, have been reported in Asian Indians, suggesting that primary prevention strategies should be initiated early in this ethnic group. In lieu of the epidemic increase in the prevalence of obesity and diabetes mellitus in most industrialized countries including China and India owing to Westernization, urbanization, and mechanization, and evidence suggesting a pathogenetic role of obesity in the development of PCOS and related infertility, active intervention to combat the malice of these disorders is warranted. Pharmacologic therapy is a critical step in the management of patients with metabolic syndrome when lifestyle modifications fail to achieve the therapeutic goals, and studies in China and India have proved to be effective.
Article
There is substantial heterogeneity of symptoms and signs among women with polycystic ovary syndrome (PCOS). In addition to different diagnostic criteria used, the ethnic background of women with PCOS may affect the clinical, hormonal, and metabolic characteristics of this condition. We present here studies related to the clinical, hormonal, and metabolic characteristics and response to the treatment of PCOS in Asia, which may be different from those in Western countries. It is important to take into consideration the ethnic background of patients in future studies related to PCOS.
Article
Acne vulgaris may be a manifestation of hyperandrogenism. An appropriate, thorough history and physical exam will identify evidence of androgen excess. An understanding of normal androgen production and conditions of androgen excess is critical when evaluating for hyperandrogenism. Laboratory screening for hormonal abnormalities is imperative when clinical signs of hyperandrogenism are present.
Article
Acne vulgaris remains one of the most common conditions affecting adolescents. The pediatric practitioner is the first to evaluate adolescent acne, making familiarity with the condition and its management essential. This review covers some of the recent literature regarding acne to help practitioners stay current on the issues regarding this topic. The pathogenesis of acne is multifactorial and complex, but recent advances in molecular genetics have provided additional information on the actions of Proprionibacterium acnes. Nutritional studies have reevaluated a possible role for diet and lifestyle factors in acne development. Many therapies are available to control acne and to limit associated scarring. Their appropriate use requires an understanding of not only the benefits but also the possible risks and adverse effects involved. Recent concerns regarding the use of antibiotics and isotretinoin will be addressed. This study reviews the recent literature regarding teenage acne, focusing on pathogenesis, associations, and controversies and considerations in therapy.
Diabetic mellitus and other endocrine diseases Fitzpatrck's Dermatology in General Medicine
  • Aa Kalus
  • Aj Chien
  • Je Olerud
  • K Wolff
  • La Goldsmith
  • Si Katz
.Kalus AA, Chien AJ, Olerud JE. Diabetic mellitus and other endocrine diseases. In: Wolff K, Goldsmith LA, Katz SI et al., editors. Fitzpatrck's Dermatology in General Medicine. 7 th ed. New York: McGraw-Hill; 2008. P. 1462-1482.