Dark Patches in Patients with PCOS

Uneven, velvety patches of darkened and thickened skin may be seen on certain areas on the skin of individuals with PCOS. It occurs in areas with skin folds and is most commonly seen on the back of the neck, under arms and groin. The skin in these areas appears warty, thick and brown to black to grey.

This condition is termed Acanthosis Nigricans or AN (Acanthosis means an abnormal thickening of the skin, while Nigra implies darkness.) AN is not a diagnostic symptom of PCOS, as AN occurs due to a wide variety of causes; hormonal imbalance like that seen in PCOS is merely one of them. However, the finding is significant in women with other symptoms of PCOS as it signals insulin resistance. The appearance of unsightly dark patches may first prompt an individual to seek medical attention and undergo evaluation. AN is cosmetically unpleasant and often becomes a gateway to further discussion regarding PCOS during a dermatological consult. 

Remedies for AN in patients with PCOS:

1. The underlying cause of AN must first be determined and treated appropriately. Obesity, hormonal imbalance (such as Cushing's syndrome or PCOS), family tendency or rarely tumours elsewhere in the body may cause AN. In women with PCOS, AN signals the presence of insulin resistance. 

To correct this underlying insulin resistance the patient may be treated with medication such as metformin or with newer supplements containing n-Acetyl Cysteine and alpha lipoic acid. In addition it is important to maintain an active lifestyle with regular exercise and to follow a balanced diet incorporating leafy vegetables while limiting intake of sugary processed foods and high glycemic index foods, principles which are common to all individuals with PCOS.

2. Gentle resurfacing of skin with chemical peels or mild microdermabrasion in conjunction with topical medication (preparations containing urea and salicylic acid) gives good results. 

The Biology of PCOS: Simplified

Polycystic Ovarian Syndrome is the commonest hormonal imbalance in women across the world. 

Although the name suggests the presence of cysts in ovaries of all those affected, this is simply not true. The syndrome causes a cluster of symptoms and any affected person may have none, one or more symptoms in any combination. 

The syndrome mainly does three things, which have a complex cause-effect relationship with the other:

1) Resistance of cells to the effect of the hormone Insulin, which causes disturbance of digestion of sugars. This in turn can cause diabetes and storage of eaten sugars as fat. Insulin resistance contributes to acne, weight gain and other symptoms.

2) Excessive production of male hormones or androgens in the female body, which is exaggerated in the presence of excess fat, especially around the abdomen. The presence of excess amounts of male hormones causes unwanted facial and body hair, acne and hair loss from the scalp.

3) The disturbance of hormone profiles is in turn associated with a disruption of the normal menstrual cycle. The usual process of ovulation is interrupted, causing anovulatory cycles, which further changes the pattern of secretion of male and female hormones in the body. 

Problems in conception, irregularities of timing, heavy painful periods and cramps may or may not be seen in these anovulatory cycles. 

Keeping the above in mind, some experts opine that 'Anovulatory Androgen Excess' is a better terminology than PCOS for this condition. Research shows that despite the common occurrence of the syndrome, up to fifty percent of women with PCOS are not aware of their diagnosis. Thus it is imperative to work towards creating an increased awareness of the symptoms, as well as acceptance of the diagnosis and instillation of hope in women exasperated by these seemingly disconnected and vague symptoms. 

PCOS is a challenge that can easily be vanquished with appropriate lifestyle modification and treatment. To this end, PCOS Initiative aims to work towards providing support and education about this condition, to help women take charge of their own well-being, and overcome the impact of PCOS on their lives. We choose to focus on the cosmetic changes of PCOS, namely the changes in skin, hair and body weight, which can the affect the self-esteem of affected women and in some cases also their personal and professional lives. 

What Causes PCOS:

The exact cause of PCOS remains a subject of research. A number of factors have been identified which influence the appearance and course of the condition.

Image: Teede et Al, BMC Medicine 2010

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Image: Rotstein, Srinivasan and Won

Not all patients with PCOS would have evidence of cysts in the ovaries on ultrasound, just as not all of them would have all the skin/hair/fertility/weight/period related symptoms of PCOS.

Where do the androgens come from?

Androgens or male hormones are produced in the ovaries, due to a disturbance in ovulation.

Image: utendocrinology.com

Image: Hector F, Escobar-Morreale

Image: Implementdesignism.org

What is Insulin Resistance?

Insulin is a hormone produced by the pancreas in our body. Insulin Resistance means that the tissues of an individual are resistant to the action of insulin. The major action of insulin is to digest glucose or sugar. Thus, simply put, Insulin Resistance means that a person is unable to digest sugar properly, leading to various symptoms, and storage of sugar as fat.

Image: singhealth.com

Stemoxydine is a new molecule developed by the L'oreal research team which claims to treat hair loss and induce new growth. Laboratory and clinical tests conducted at the French facility of L'oreal have shown some promise: In a double blind trial versus placebo on 101 men aged between 18 and 55 years, once daily application of Stemoxydine 5% solution (6ml), showed an increase of 4% in hair density on the patients treated with Stemoxydine (represents an average of + 1700 hair) at the end of the 3 months. The molecule has been launched in anti hair loss preparations under various brand names including Dercos Neogenic. The product is currently priced on the higher end in its class and is available in Europe and with select clinics in Asia.

Disclaimer

The author does not accept any liability to any person for the information or advice (or use of such information or advice) which is provided on this page or incorporated into it by reference.  
This information is not intended to be medical advice/opinion. It is provided with the understanding that all persons accessing it take responsibility for assessing its relevance & accuracy. Readers are requested to discuss their specific health needs with their respective treating physicians.

About Us

PCOS Initiative aims to demystify the common yet poorly understood issue of PCOS (Poly-cystic Ovarian Syndrome), and thereby enable women with PCOS to take charge of their own health. It works to help women learn to identify, manage & minimise the cosmetic impact of PCOS on their lives.

The author, Sonam Yadav, is a trained medical doctor who specializes in cosmetic dermatology and routinely treats PCOS patients for various dermatological concerns including oily skin, acne and acne scars, hirsutism, hair loss/thinning, uneven pigmentation, acanthosis nigricans, skin tags, skin laxity and stretch marks. This interaction has reinforced the belief that clear communication & patient education can improve overall well-being and treatment outcomes, especially in chronic conditions.

PCOS Initiative is an extension of this belief and effort towards patient empowerment.

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Online content is educational, not medical advice. Please discuss with treating physician in person.