Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-55f67697df-4ks9w Total loading time: 0 Render date: 2025-05-09T04:36:14.038Z Has data issue: false hasContentIssue false

8 - Skin manifestations of polycystic ovary syndrome

Published online by Cambridge University Press:  29 September 2009

By
Rodney Sinclair  and
Jack Green
Edited by
Gabor T. Kovacs  and
Robert Norman
Rodney Sinclair
Affiliation:
University of Melbourne Department of Dermatology
Jack Green
Affiliation:
University of Melbourne Department of Dermatology
Gabor T. Kovacs
Affiliation:
Monash University, Victoria
Robert Norman
Affiliation:
University of Adelaide
Get access

Summary

Introduction

The pilosebaceous unit consists of the hair follicle and associated sebaceous and apocrine glands. Hair follicles and sebaceous glands have cellular androgen receptors and react to circulating androgens. Physiological androgen levels induce secondary sexual hair development at puberty, and mild acne is a near universal accompaniment. Androgens also induce pattern hair loss the prevalence and severity increasing with age. Polycystic ovary syndrome (PCOS) is associated with androgen excess and may induce hirsutism and seborrhea and accentuate androgenetic alopecia and acne (Table 8.1). Acanthosis nigricans is a cutaneous marker of insulin resistance that is also associated with PCOS.

Physiology of the sebaceous gland

Sebaceous glands occur on all parts of the skin except on the glabrous skin of the palms and soles. They are most numerous on the face, scalp, and back occurring at a concentration of between 400 and 900 glands per square centimeter. Each of the several lobes of the gland has a duct lined with keratinizing squamous epithelium, and these join to form a main duct that enters the follicular canal. Glandular cells, which divide at the periphery, move towards the center of the glands and become increasingly filled with sebaceous material. During this process, cells undergo complete dissolution and discharge all cellular contents into the sebaceous duct. The lipid composition of sebum differs from epidermal lipid in that it contains wax esters and squalene that the former does not, although there are a similar percentage of glycerides (Cunliffe and Simpson 1998).

Type
Chapter
Information
Polycystic Ovary Syndrome , pp. 102 - 120
Publisher: Cambridge University Press
Print publication year: 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Adams, J., Polson, D., and Franks, S. (1986) Prevalence of polycystic ovaries in women with anovulation and idiopathic hirsutism. Br. Med. J. 293:355–358.CrossRefGoogle ScholarPubMed
Bailey-Pridham, D. and Sanfilippo, J. (1989) Hirsutism in the Adolescent Female. Pediatr. Clin. 36:581–599.CrossRefGoogle ScholarPubMed
Balen, A., Conway, G., Kaltsas, G., Techatraisak, K., and Manning, P. (1995) Polycystic ovary syndrome: the spectrum of the disorder in 1741 patients. Hum. Reprod. 10:2107–2111.CrossRefGoogle ScholarPubMed
Barth, J., Cherry, C., and Wojnarowska, F. (1991) Cyproterone acetate for severe hirsutism results of a double-blind dose-ranging study. J. Clin. Endocrinol. Metab. 35:5–10.Google ScholarPubMed
Betti, R., Bencini, P., Lodi, A., et al. (1990) Incidence of polycystic ovaries in patients with late-onset or persistent acne: hormonal reports. Dermatologica 181:109–111.CrossRefGoogle ScholarPubMed
Biondo, S., Goble, D., and Sinclair, R. (2004) Women who present with female pattern hair loss tend to underestimate the severity of their hair loss. Br. J. Dermatol. 150:750–752.CrossRefGoogle ScholarPubMed
Birch, M. P. and Messenger, A. G. (2003) Frontal recession in women: no correlation with hair density. Exp. Dermatol. 12:231.Google Scholar
Burton, J. and Shuster, S. (1971) The relationship between seborrhoea and acne vulgaris. Br. J. Dermatol. 84:600–602.CrossRefGoogle ScholarPubMed
Castello, R., Tosi, F., Perrone, F., et al. (1996) Outcome of long-term treatment with 5a-reductase inhibitor finasteride in idiopathic hirsutism: clinical and hormonal effects during a 1-year course of therapy and 1-year follow-up. Fertil. Steril. 66:734–740.CrossRefGoogle Scholar
Conn, J. and Jacobs, H. (1998) Managing hirsutism in gynaecological practice. Br. J. Obstet. Gynaecol. 105:687–696.CrossRefGoogle ScholarPubMed
Conway, G. and Jacobs, H. (1990) Acanthosis nigricans in obese women with the polycystic ovary syndrome: disease spectrum not distinct entity. Postgrad. Med. J. 66:536–538.CrossRefGoogle Scholar
Conway, G., Honour, J., and Jacobs, H. (1989) Heterogeneity of the polycystic ovary syndrome: clinical endocrine and ultrasound features in 556 patients. Clin. Endocrinol. (Oxf.) 30:459–470.CrossRefGoogle ScholarPubMed
Corenblum, B. and Baylis, B. (1990) Medical therapy for the syndrome of familial virilization, insulin resistance, and acanthosis nigricans. Fertil. Steril. 53:421–425.CrossRefGoogle ScholarPubMed
Cunliffe W. and Simpson N. (1998) Disorders of sebaceous glands. In Champion, R., Burton, J., Burns, D., and Breathnach, S., (eds.) Rook/Wilkinson/Ebling Textbook of Dermatology, pp. 1927–1984. Oxford, UK: Blackwell Science.
Cusan, L., Dupont, A., Belanger, A., et al. (1990) Treatment of hirsutism with the pure antiandrogen flutamide. J. Am. Acad. Dermatol. 23:462–469.CrossRefGoogle ScholarPubMed
Darley, C., Kirby, J., Besser, G., et al. (1982) Circulating testosterone, sex hormone binding globulin and prolactin in women with late onset or persistent acne vulgaris. Br. J. Dermatol. 106:517–522.CrossRefGoogle ScholarPubMed
Dawber, R. P. R. and Sinclair, R. D. (2001) Hirsuties. Clin. Dermatol. 19:189–199.CrossRefGoogle ScholarPubMed
Villez, R. and Dunn, J. (1986) Female androgenic alopecia. Arch. Dermatol. 122:1011–1015.CrossRefGoogle ScholarPubMed
Villez, R., Jacobs, F., Szpunar, C., and Warner, M. (1994) Androgenetic alopecia in the female: treatment with 2% topical minoxidil solution. Arch. Dermatol. 130:303–307.Google Scholar
Derksen, J., Moolenaar, A., Seters, A., and Kock, D. (1993) Semiquantitative assessment of hirsutism in Dutch women. Br. J. Dermatol. 128:259–263.CrossRefGoogle ScholarPubMed
Dunaif, A., Hoffman, A., Scully, R., et al. (1985) Clinical, biochemical and ovarian morphologic features in women with ancanthosis nigricans and masculanization. Obstet. Gynecol. 66:545–552.Google Scholar
Eden, J. (1991) The polycystic ovary syndrome presenting as resistant acne successfully treated with cyproterone acetate. Med. J. Austral. 155:677–680.Google ScholarPubMed
Falsetti, L. and Galbignani, E. (1990) Long-term treatment with the combination ethinylestradiol and cyproterone acetate of polycystic ovary syndrome. Contraception 42:611–619.CrossRefGoogle ScholarPubMed
Falsetti, L., Fusco, D., Eleftherioiu, G., and Rosina, B. (1997) Treatment of hirsutism by finasteride and flutamide in women with polycystic ovary syndrome. Gynecol. Endocrinol. 11:251–257.CrossRefGoogle ScholarPubMed
Ferriman, D. and Gallwey, J. (1961) Clinical assessment of body hair growth in women. J. Clin. Endocrinol. 21:1440–1447.CrossRefGoogle ScholarPubMed
Franks, S. (1988) Polycystic ovary syndrome: a changing perspective. Clin. Endocrinol. (Oxf.) 31:87–118.CrossRefGoogle Scholar
Gan, D. and Sinclair, R. (2004) Prevalence of male and female pattern hair loss in Maryborough. J. Invest. Dermatol. Symp. Proc. 10:184–189.CrossRefGoogle Scholar
Goldzieher, J. and Axelrod, L. (1963) Clinical and biochemical features of polycystic ovarian disease. Fertil. Steril. 14:631.CrossRefGoogle ScholarPubMed
Hamilton, E. and Potten, C. (1974) The effect of repeated plucking on mouse skin cell kinetics. J. Invest. Dermatol. 62:560–562.CrossRefGoogle ScholarPubMed
Held, B., Nader, S., Rodriguez-Rigau, L., Smith, K., and Steinberger, E. (1984) Acne and hyperandrogenism. J. Am. Acad. Dermatol. 10:223–226.CrossRefGoogle ScholarPubMed
Holmes, R., Williams, M., and Cunliffe, W. (1972) Pilo-sebaceous duct obstruction and acne. Br. J. Dermatol. 87:327–332.CrossRefGoogle ScholarPubMed
Inui, S., Fukuzato, Y., Nakajima, T., Yoshikawa, K., and Itami, S. (2003) Identification of androgen-inducible TGF-beta1 derived from dermal papilla cells as a key mediator in androgenetic alopecia. J. Invest. Dermatol. Symp. Proc. 8:69–71.CrossRefGoogle ScholarPubMed
Kiddy, D., Sharp, D., White, D., et al. (1990) Difference in clinical and endocrine features between obese and non-obese subjects with polycystic ovary syndrome: an analysis of 263 consective cases. Clin. Endocrinol. (Oxf.) 32:213–220.CrossRefGoogle Scholar
Kiddy, D., Hamilton-Fairley, D., Bush, A., et al. (1992) Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clin. Endocrinol. (Oxf.) 36:105–111.CrossRefGoogle ScholarPubMed
Levell, M., Cawood, M., Burke, B., and Cunliffe, W. (1989) Acne is not associated with abnormal plasma androgens. Br. J. Dermatol. 120:649–654.CrossRefGoogle Scholar
Lobo, R. (1991) Hirsutism in polycystic ovary syndrome: current concepts. Clin. Obstet. Gynecol. 34:817–826.CrossRefGoogle ScholarPubMed
Lucky, A., Biro, F., Huster, G., et al. (1994) Acne vulgaris in premenarchal girls. Arch. Dermatol. 130:308–314.CrossRefGoogle ScholarPubMed
Ludwig, E. (1977) Classification of the types of androgenetic alopecia (common baldness) occurring in the female sex. Br. J. Dermatol. 97:247–254.CrossRefGoogle ScholarPubMed
Marynick, S., Chakmakjian, Z., McCaffree, D., and Herndon, J. (1983) Androgen excess in cystic acne. N. Engl. J. Med. 308:981–986.CrossRefGoogle ScholarPubMed
McKnight, E. (1964) The prevalence of “hirsutism” in young women. Lanceti:410–413.CrossRefGoogle Scholar
Messenger A., Sinclair R., and De Berker D. (2004) Hair disorders. In Champion, R., Burton, J., Burns, D., and Breathnach, S. (eds.) Rook/Wilkinson/Ebling Textbook of Dermatology pp. 63–83. Oxford, UK: Blackwell Science.
Miller, J., Darley, C., Karkavitsas, K., Kirby, J., and Munro, D. (1982) Low sex-hormone binding globulin levels in young women with diffuse hair loss. Br. J. Dermatol. 106:331–336.CrossRefGoogle ScholarPubMed
O'Driscoll, J., Mamtora, H., Higginson, J., et al. (1994) A prospective study of the prevalence of clear-cut endocrine disorders and polycystic ovaries in 350 patients presenting with hirsutism or androgenic alopecia. Clin. Endocrinol. (Oxf.) 41:231–236.CrossRefGoogle ScholarPubMed
Olsen, E. (1999) Methods of hair removal. J. Am. Acad. Dermatol. 40:143–157.CrossRefGoogle ScholarPubMed
Piacquadio, D., Rad, F., Spellman, M., and Hollenbach, K. (1994) Obesity and female androgenic alopecia: a cause and effect?J. Am. Acad. Dermatol. 30:1028–1030.CrossRefGoogle Scholar
Rendon, M., Cruz, P., Sontheimer, R., and Bergstresser, P. (1989) Acanthosis nigricans: a cutaneous marker of tissue resistance to insulin. J. Am. Acad. Dermatol. 21:461–469.CrossRefGoogle ScholarPubMed
Ruutiainen, K. (1986) The effect of an oral contraceptive containing ethinylestradiol and desogestrel on hair growth and hormonal parameters of hirsute women. Int. J. Gynaecol. Obstet. 24:361–368.CrossRefGoogle ScholarPubMed
Ruutiainen, K., Erkkola, R., Gronroos, M., and Irjala, K. (1988) Influence of body mass index and age on the grade of hair growth in hirsute women of reproductive ages. Fertil. Steril. 50:260–265.CrossRefGoogle ScholarPubMed
Ryan T. J. and Sinclair R. D. (2003) Diseases of the skin. In Warrell, D. A., Cox, T. M., Firth, J. D., and Benz, E. J. (eds.) Oxford Textbook of Medicine, 4th edn. Oxford University Press, Oxford, 3:804–902.CrossRef
Schwartz, R. (1994) Acanthosis nigricans. J. Am. Acad. Dermatol. 31:1–19.CrossRefGoogle ScholarPubMed
Shum, K. W., Cullen, D. R. and Messenger, A. G. (2002) Hair loss in women with hyperandrogenism: four cases responding to finasteride. J. Am. Acad. Dermatol. 47:733–739.CrossRefGoogle ScholarPubMed
Simpson N. B. and Barth J. H. (1997) Hair patterns: hirsuties and androgenetic alopecia. In Dawber, R. (ed.) Diseases of the Hair and Scalp. Sydney, Australia, Blackwell Science, pp. 67–82.Google Scholar
Sinclair, R., Magee, J., and Chapman, A. (2004a) Changes in scalp hair follicle density with advancing age. Br. J. Dermatol. 152:646–649.CrossRefGoogle Scholar
Sinclair, R., Jolley, D., Mallari, R., and Magee, J. (2004b) The reliability of horizontally sectioned scalp biopsies in the diagnosis of chronic diffuse telogen hair loss in women. J. Am. Acad. Dermatol. 51:189–199.CrossRefGoogle Scholar
Sinclair, R., Wewerinke, M., and Jolley, D. (2004c) Treatment of female pattern hair loss with oral antiandrogens. Br. J. Dermatol. 152:466–473.CrossRefGoogle Scholar
Sperling, L. and Heimer, W. (1993) Androgen biology as a basis for the diagnosis and treatment of androgenic disorders in women. I. J. Am. Acad. Dermatol. 28:669–681.CrossRefGoogle ScholarPubMed
Thai, K. E. and Sinclair, R. D. (2002) Finasteride for female androgenetic alopecia. Br. J. Dermatol. 147:812–813.CrossRefGoogle ScholarPubMed
Tolino, A., Petrone, A., Sarnacchiaro, F., et al. (1996) Finasteride in the treatment of hirsutism: new therapeutic perspectives. Fertil. Steril. 66:61–65.CrossRefGoogle ScholarPubMed
Trotter, M. (1923) The resistance of hair to certain supposed growth stimulants. Arch. Derm. Syph. 7:93–98.CrossRefGoogle Scholar
Venning, V. and Dawber, R. P. R. (1988) Patterned androgenic alopecia in women. J. Am. Acad. Dermatol. 18:1073–1077.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×