Thursday, 11 August 2016

Beginner's guide to PCOS

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Whether you or a loved one have been recently diagnosed with PCOS or have been struggling with it for a while now, the important thing to know is that PCOS can be controlled so that it does not have any major impact on your body or life.

With a clear understanding of the challenges in your path and with resolve, you can modify your lifestyle and seek medical aid to overpower this condition. While it has a genetic component thus cannot be 'cured', with the correct changes there is every chance you can ensure that you do not have any symptoms/complications and remain 'PCOS free' for life.


Cosmetic Impact of PCOS

Women with PCOS may notice some/none/several of these symptoms in any combination. These changes are simply external manifestations or sequelae of the hormonal changes that occur within.
  • Acne over the face or body, which can sometimes flare up around periods. 
  • Acne may be painful, severe or hard to treat and may occur at any age 
  • Oily skin; Blackheads and Whiteheads (These are also a form of acne) 
  • Pigmented or Pitted Marks and Scars left behind by Acne on the face/body 
  • Excessive or Increasingly Coarse Hair, on the Body (such as the abdomen and chest) or on the Face (such as on the chin, cheeks and jawline) 
  • Coarse hair may lead to Ingrown Hair and Bumps 
  • Thinning of Scalp Hair, sometimes associated with Dandruff 
  • Hair Loss, Alopecia or Balding 
  • Thickening or Darkening of Skin Creases, including Armpits and Neck 
  • Skin Tags, commonly in the Armpits or Neck 
  • Possible Association: Boils/sinuses in skin folds - Hidradenitis Suppurativa
However, the primary aim of this initiative is not to be a repository of information. That job is best left to a search engine. Our aim is to facilitate an understanding of this information in a manner that simplifies the life of an individual with PCOS. With this goal in mind, we offer here a simplistic approach to the cosmetic impact of this syndrome.  

While the information here comes from a trained physician, it is aimed at patient education. It is neither intended, nor adequate, to qualify as medical opinion for any individual. Please use this information to better understand the various approaches to tackling PCOS and discuss the same with your treating physician in person.


SKIN

  • Oily Skin
  • Acne
  • Acne Scars
  • Body Acne
  • Unwanted Facial Hair

ACNE

Acne may occur at any age, over the face or body, with or without any measurable imbalance in the hormonal profile or any other symptoms of PCOS. Sometimes an individual may not have acne, but be prone to oily irritable skin or have the occasional blackhead or whitehead. On the other hand some people have debilitating severe, painful and widespread acne in the form of pimples, cysts or hard lumps under the skin, which leaves behind pits and scars.


The best time to treat acne is As Soon As Possible. This helps to minimize skin damage and prevents the spread of acne, scarring or uneven pigmentation. However, it is important to not try to self-medicate. Doctors are trained to identify the severity of your acne and treat it with the correct strength of medication. Over-the-counter and herbal products may be suitable for maintenance of oily skin, but usually do not contain the higher strengths of medication required to combat active acne.

It is also important to understand that acne can be controlled and kept at bay. However this takes time and one must not lose faith in treatments or give up on a doctor/product/regimen.

Acne needs consistent management and good skin care even when all of it has been treated. When a person has oily or acne prone skin, maintenance regimes are vital, as acne has a terrible tendency to return, sometimes with a vengeance, often just when you're stressed about wanting to look your best. Stress, however, is fuel to the fire of acne. The best thing to do is to take control of acne, treat it with the right medication under medical supervision and to go out and live life and have fun, as you would.

Prevention of acne with the use of appropriate skin care products and a good lifestyle go a long way. Despite the tremendous urge to extract a visible blackhead or to pop a zit, the best thing to do is to apply medication as advised and leave your acne alone. Without this, deep pitted scars can form, which take more time, money and effort to treat than active acne alone would require.

It is important to understand your skin needs, and to follow a good medicated regimen. Patient counseling and education are therefore the most critical elements for treating acne.
BODY

  • Unwanted Hair on the Body
  • Stretch Marks or Striae
  • Pigmentation or Acanthosis Nigricans
  • Skin Tags
  • Ingrown Hair
  • ?Hidradenitis Suppurativa

LASER HAIR REDUCTION FOR UNWANTED BODY HAIR

A Laser is just a focused beam of light. Depending on the source, wavelength and intensity of light, lasers may be used for a wide range of purposes from eye surgery to industrial cutting. There are several types of lasers used in dermatology, such as those treating spider veins, birth marks, wrinkles, scars, pigmentation, excessive hair, tattoos and more.

Lasers used for permanent hair reduction are also of different types such as Nd:YAG and Diode technologies. The depth of penetration of lasers for hair reduction differs from those used for treatment of other concerns. Lasers work on the actively dividing cells in the root of the hair follicle, effectively killing the hair from the root. However, as all hair is not in this susceptible stage at the same time, multiple sessions are needed at many weeks of intervals.

Not all lasers are made the same and the appropriate technology should be selected by an experienced professional, depending on the person's skin and hair type. Permanent laser hair reduction is an extremely safe, comfortable and effective way to get rid of unwanted body hair. However, it is essential that the laser operator has adequate training, follows safety precautions and proper treatment protocol with correct gap between treatment sessions.
 STRETCH MARKS OR STRIAE


Stretch marks occur due to damage to collagen, a protein present in the dermal layer of skin. Collagen is vital for keeping skin tight and smooth. Undue stretching of skin beyond it's normal capacity, such as during sudden weight loss or gain, pregnancy and growth spurts, damages this collagen, leading to the formation of Stretch Marks or Striae. New stretch marks are reddish/purple while older ones look silvery/white.

TREATMENT:

The single best treatment for stretch marks is PREVENTION . For this one requires intense moisturizing and gradual weight loss or gain. Creams such as those containing vitamin A derivatives, called Retinoids/ silicone/ onion extract give limited improvement. Microneedling with DermaRollers may have deeper impact and better visible outcome. Lasers meant for skin resurfacing penetrate deeper and boost collagen synthesis to give visible results. Recent stretch marks seem to respond faster and better to treatment than very old striae.

HAIR LOSS
  • Hair Fall and Thinning
  • Dandruff
  • Baldness or Receding Hairline
Many individuals first notice a large number of hair falling out, while combing or shampooing their hair. Thinner, scraggly looking hair or a loss in volume may be reported by others. In severe cases, hair fall may manifest as a bald patch or receding hairline.

Hair loss is of several types and may occur due to reasons as diverse as infection or poor nutrition, pregnancy, severe stress or harsh chemical based hair treatments. Hormonal imbalance is just one of the factors which can lead to increased hair loss and thinning. Dietary deficiencies, anemia, thyroid imbalance or other causes may coexist with PCOS and contribute to hair loss. Thus all these possible contributory factors should be assessed and treated.
  • The procedure for effective treatment of hair loss must begin with a detailed medical history. 
  • This is followed by laboratory investigations such as blood tests, as seen fit by the treating physician. The laboratory tests may help identify or rule out certain causative factors like anemia. In PCOS patients, severe imbalance of hormones may reflect in laboratory reports and explain any increase in hair loss. 
  • Treatment for hair fall may include a combination of home-care application based products, oral supplements and in-clinic treatments. 
  • In many patients with PCOS, dandruff, flakiness/itching of the scalp and oiliness of hair may coexist with hair loss. Dandruff further contributes to hair loss and therefore must be treated for good results. 
  • There are treatments available for arresting hair loss and promoting new hair growth. However, the results of medication take a few weeks to become evident. Therefore, it is imperative that an individual be consistent and patient with treatment for hair loss. 
  • Lifestyle modification, stress management and a holistic approach to PCOS, must continue along with prescription medication for best results. 
  • Oral supplements for hair loss usually contain Biotin, Iron and Saw Palmetto, and other vitamins and micronutrients. Saw Palmetto is a plant derivative which acts as an anti androgen, thus working as a natural alternative to finasteride for the treatment of hormonal hair loss in PCOS 
There is a plethora of information regarding PCOS available online as well as offline. The following are good places to start:


PCOS Fact Sheet by the Office on Women's Health, US Department of Health and Human Services
WebMD

Tuesday, 21 June 2016

Skin Conditions linked to Insulin Resistance


Journal Review:

ScientificWorldJournal. 2015; 2015: 479354.
Published online 2015 Apr 21. doi:  10.1155/2015/479354

Insulin Resistance and Skin Diseases"

Authors: Maddalena Napolitano, * Matteo Megna, and Giuseppe Monfrecola
Section of Dermatology, Department of Medicina Clinica e Chirurgia, University Federico II, Napoli, Italy

----------------

Excerpts from the published article:

Skin diseases associated with insulin resistance.
Skin disorders and insulin resistance (IR)
Conditions strongly associated with IRConditions potentially associated with IRConditions anecdotally linked to IR
Acanthosis nigricansAcrochordons (skin tags)Alopecia areata
AcneAndrogenetic alopeciaVitiligo
PsoriasisHidradenitis suppurativa
Hirsutism
Hyperandrogenism
  • (IR - leads to Hyperinsulinemia which leads to Hyperandrogenism)
  • Hyperandrogenism is a common endocrine disorder of women of reproductive age with a prevalence of 5–10%. 
  • The most frequent hyperandrogenic-linked disorder is the polycystic ovary syndrome (PCOS). It shows an 80–85% prevalence among women with excess androgen and is also closely linked to IR. 
  • The clinical signs of hyperandrogenism are very important especially for the dermatologist since they include the following: hirsutism, alopecia, seborrhea, acne, and, in severe cases, signs of virilization (deepening of the voice, increased muscle mass, clitoromegaly, decreased breast size, and amenorrhea), highlighting the wide clinical scenario which is related to IR and hyperinsulinemia. 

Saturday, 12 March 2016

Hirsutism and Acanthosis Nigricans Are the Most Reliable Markers of PCOS, finds study


From PracticeUpdate:
74th Annual Meeting of the American Academy of Dermatology; March 8, 2016—Washington DC

Timothy Hunter Schmidt, MD, PhD, of the University of California, San Francisco, and a research team led by Kanade Shinkai, MD, PhD set out to identify cutaneous and systemic features of polycystic ovary syndrome (PCOS) to help distinguish women who do and do not meet diagnostic criteria. Dr. Shinkai said, “We undertook the study to better understand the skin manifestations of polycystic ovary syndrome. It was the first study to systematically characterize the detailed skin findings of this disease in a large, racially diverse cohort of women.”

The team studied a racially diverse referred sample of women seen at their polycystic ovary syndrome multidisciplinary clinic over a 6-year period between 2006 and 2012.

The team concluded that:

  •  Hirsutism and acanthosis nigricans are the most reliable cutaneous markers of polycystic ovary syndrome and require a comprehensive skin examination to diagnose. 
  • When present, hirsutism and acanthosis nigricans should raise clinical concern that warrants further diagnostic evaluation for metabolic comorbidities that may lead to long-term complications. 
  • Acne & androgenic alopecia are prevalent but unreliable markers of biochemical hyper androgenism in this population.
  • “A significant result of the study is that it helps identify key skin features that distinguish women with polycystic ovary syndrome from those suspected of having the syndrome but do not have the disease. This information will hopefully improve the diagnostic accuracy of clinicians assessing these patients (and also avoid unnecessary diagnostic workup of women who do not need it).” 
  • “Future directions include understanding the skin findings in subtypes of polycystic ovary syndrome and also, the best medical and surgical treatments for the syndrome.”

Tuesday, 8 March 2016

PCOS in Indian Women

1 in 5 Indian women suffer from PCOS and those aged 15 to 30 years were at higher risk - according to a study conducted in September 2015.
One in five Indian women suffer from Polycystic Ovary Syndrome (PCOS), a condition characterised by hormonal imbalance, leading to difficulties in conceiving, according to a study.
The study conducted by Metropolis healthcare also stated that women in the age group of 15-30 years were at high risk.
For the study, some 27,411 samples were tested over a period of 18 months.
"The increasing trend of PCOS is predominantly seen in the age group 15 to 30 years. Out of 27,411 samples, around 4,824, (17.60 percent) of the females face hormonal associated risk with Polycystic Ovary Syndrome," said the report.
PCOS is a problem in which a woman's hormones are out of balance due to which several cysts are formed in the ovary. It can interfere with women's menstrual cycle and make it difficult to get pregnant. PCOS may also cause unwanted changes in the way women look.
The study said that among the samples tested, east India showed alarming levels of 25.88 percent women affected by PCOS, followed by 18.62 percent in north India, which can be largely attributed to lack of awareness among young women.
"Undiagnosed PCOS can lead to infertility and in long term can cause several health complications; which can be attributed to other factors as well. Early diagnosis and treatment can help control the symptoms and prevent health related problems," said Sonali Kolte, general manager, Medico Marketing, Metropolis Healthcare Ltd.
Source:  http://www.business-standard.com/article/news-ians/one-in-five-indian-women-suffer-from-pcos-study-115090100766_1.html

Tuesday, 13 January 2015


NUTRITION GUIDELINES IN PCOS 
Since the origin of most symptoms associated with PCOS is thought to be
related to insulin resistance, nutrition guidelines and lifestyle
recommendations are centered on treating insulin resistance and its long
term health effects. 
The following recommendations have proven successful in treatment: 
1. Weight Loss: even a 10% reduction in body weight will decrease
insulin resistance. Try not to eat less than 1400 kcal/day. 
2. Balanced carbohydrate intake throughout the day. Eat three
meals with 45 grams/meal and two to three snacks of 15/20 grams
each. (1400 kcal = 170 grams carbohydrate). (Individuals who are
very active or vegetarian may need at least 60 grams of
carbohydrate/meal). 
3. Do not skip meals. Try not to let more than four to five hours go
between meals/snacks to maintain stable blood sugars and diminish
extreme hunger. 
4. Gradually increase intake of high fiber carbohydrate foods,
aiming for 30 to 35 grams/day, or 15 grams/1000 kcal. 
5. Emphasize lean protein foods at 15 to 20% of total calories.
(1400 kcal = 70 grams protein) Try to include protein with most
meals and snacks. 
6. Consume about 25 to 30% of calories as fat – emphasizing low
saturated fat foods and increased monounsaturated and omega-3
fatty acid food choices. Avoid foods containing trans fats.
7. Include two to three servings of low fat dairy foods per day,
such as skim or 1% milk, yogurt, lite cheese, cottage cheese etc. 
8. Some phyto-nutrients might improve insulin resistance.
Caissia cinnamon (500 to 1000mg in water soluble capsules or 1 to
2 tsp/day of the spice); low fat dairy foods; nuts especially
walnuts; orange and leafy green vegetables such as spinach or kale;
carrots, yams and sweet potatoes. 
9. Vitamin D deficiency has been associated with insulin resistance
and reduced pancreatic beta cell function. Supplementation with
Vitamin D3 (cholecalciferol) may be beneficial. Consider taking
1500 IU of vitamin D3/day. 
10. Control portions especially from restaurants or fast food places. Most restaurant portions are 50% more than needed. Ask for the“to go” container when the meal arrives and put aside part of the meal.
High Fiber carbohydrate foods include: whole grain breads, rolls, bagels;
whole wheat pasta, brown and wild rice, high fiber cereals, oats, barley,
legumes (peas, beans and lentils), corn, bran, seeds, nuts; fresh and dried
fruit and most vegetables.
B12 absorption may be affected by long term use of metformin. A multivitamin
supplement with B12 is recommended, especially for strict
vegetarians.

Monounsaturated fat containing food choices include: avocado, canola,
olive and peanut oils; olives, nuts such as almonds, cashews, peanuts and
pecans; peanut butter, nut butters, sesame oil, seeds and paste.
Omega-3 fatty acid (specifically EPA and DHA) containing food choices
include: cold water fish such as salmon, mackerel, halibut, tuna, sardines
and herring. Two to three servings of fatty fish/week will provide the 220
mg each of EPA and DHA that is recommended. Omega-3 eggs from free
range chickens. Fish oil supplements containing 220 mg each of EPA and
DHA per day. Typically, a 1000 mg fish oil capsule contains 180 mg EPA
and 120 mg DHA. 
Flax seed is high in ALA which is normally converted to EPA and DHA.
However people with insulin resistance may not efficiently make this
conversion, so flax seed supplementation may not be beneficial.
Limit foods containing trans fatty acids, especially deep fried restaurant
foods and commercial products not labeled trans free.
Lean protein food choices include: lean beef such as sirloin, top round,
extra-lean ground beef, white meat of chicken and turkey, dark meat without
the skin, pork loin, ham, center cut lamb and pork chops, game such
venison, buffalo. Fish and shell fish; egg whites, egg substitutes, free-range
eggs, skim and 1% milk, soy milk, low-fat yogurts, cottage cheese, low-fat
or lite cheese, beef jerky. Dried beans, lentils, peas, hummus, soy products
such as veggie burgers and meat substitutes, tofu. Nuts and seeds are higher
in fat but contain healthy monounsaturated fats. 

 http://shc.osu.edu/posts/documents/nutrition-guidelines-in-pcos-p1.pdf

SOURCE: STUDENT HEALTH SERVICES
AT OHIO STATE UNIVERSITY, USA