Relation of polycystic ovarian syndrome phenotypes with cutaneous and biochemical hyperandrogenism: a case–control study

Background Understanding of polycystic ovarian syndrome (PCOS) and its phenotypes with the heterogeneous manifestations and hormonal armamentarium has been not fulfilled. Objective To elucidate dermatologic manifestations in Egyptian PCOS cohort, association of each manifestation with hormonal change, and relation of these findings with different phenotypes of PCOS. Patients and methods In this case–control study, 95 women who met the criteria of diagnosis of PCOS based on Rotterdam Consensus criteria 2003 and 50 age-matched controls underwent skin examination, anthropometric measurements (height, weight, BMI, and waist circumference), hormonal assays (total and free testosterone, dehydroepiandrosterone sulfate, prolactin, and thyroid-stimulating hormone), and homeostatic model of insulin resistance. Results Women with PCOS showed significantly higher BMI (30.71±5.94 kg/m2), waist circumference (99.94±13.01 cm), prevalence of cutaneous manifestations of hyperandrogenism (HA), total and free testosterone, dehydroepiandrosterone sulfate, and homeostatic model of insulin resistance than controls. Hirsutism was the most prevalent skin finding (45.3%) and was the only one significantly associated with elevated serum androgens. Cutaneous HA overwhelming occurred in 82%, whereas biochemical HA was detected in 55.7 % of patients with PCOS. The prevalence of PCOS phenotypes was A (55.8%), B (8.4%), C (25.3%), and D (10.5%). Cutaneous HA and biochemical HA were the most common in phenotype A and least in phenotype D and intermediate in phenotypes B and C. Conclusion The effect of PCOS on skin seems to be greater than on serum androgen levels. Hirsutism was the most prevalent cutaneous feature and the only major indicator of HA, followed by acne. A small percentage of patients with PCOS can show neither clinical nor biochemical HA. Phenotype A was the most severe, whereas phenotype D was the least severe, and B and C were intermediate forms.