Accumulation of sebum establishes a milieu conducive for the proliferation of Propionibacterium acnes and the eventual formation of comedones. Hyperinsulinemia in the setting of PCOS potentiates the excretion of sebum through the effects of insulin acting on IGF-1 receptors present on sweat glands.Asian Indians have the highest prevalence, with the lowest being among Pacific Islanders. Brady Prashanth Rawla., CC BY-SA 4.0 AcneĪcne is a common skin manifestation of PCOS, with a highly variable prevalence, based on ethnicity. Additional mechanisms accounting for hyperinsulinemia-induced hirsutism have been described earlier. Hyperinsulinemia stimulates keratinocytes and fibroblasts directly, leading to their proliferation. 50% of patients with the classic obese PCOS phenotype have AN. It is a velvety, dark, and plaque-like skin lesion with a predilection for flexural areas such as the neck and axillary regions. ![]() Acanthosis nigricansĪcanthosis nigricans (AN) is a classic dermatologic manifestation of PCOS and other endocrinopathies associated with insulin resistance. ![]() For example, hirsutism tends to be more common in women of Mediterranean background and less frequent and milder in women of East Asian or Native-American background. The local concentration of 5-α-reductase in the skin varies by ethnicity. (which reduces testosterone to active dihydrotestosterone) in the pilosebaceous unit. ![]() Hirsutism, like acne, and male pattern alopecia is dependent on the local abundance of 5-α-reductase
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