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.