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Hi everyone, this lesson is on polycystic ovary syndrome or PCOS and related hormonal changes that cause certain skin findings and we'll discuss why those skin findings occur in PCOS.

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Hi everyone, this lesson is on polycystic ovary syndrome or PCOS and related hormonal changes that cause certain skin findings and we'll discuss why those skin findings occur in PCOS.

Before we talk about those skin findings let's discuss PCOS and some risk factors for getting it.

This is going to be an issue that's very common, it's actually the most common endocrinological disorder in reproductive age females worldwide and the prevalence of this condition is estimated to be anywhere from five percent to fifteen percent and some sources say even up to twenty six percent of reproductive age females could be affected by pcos depending on the diagnostic criteria used now this is a multifactorial disease as we will see there's going to be certain hormonal changes that occur that cause certain signs and symptoms.

So we're going to see that polycystic ovary syndrome is going to involve excess production of androgens, which are male sex hormones, with concomitant insulin resistance.

So we're going to see higher levels of insulin or changes in insulin signaling that also lead to or are related to increased levels of androgens.

Now risk factors for getting PCOS include the following.

Genetics, so if you have a family history of PCOS you're more likely to get it yourself.

If you have obesity or if you're overweight, you're also more likely to have PCOS.

If you had an early onset minority, which is your first period, this is also associated with a higher risk of PCOS.

Large or small for gestational age, so if you were born either too large or too small, this is also associated with PCOS.

Valproic acid use is also associated.

And another associated factor that could increase the risk is perhaps increased fetal androgen exposure.

So while you are a fetus, perhaps you are exposed to higher amounts of androgen than average or higher than normal.

That could be associated with an onset of PCOS later in your life.

So a lot of what happens in PCOS has to do with what we call functional ovarian hyperandrogenism.

So the egg follicles in ovaries produce higher than normal levels of androgens.

And this is associated with higher levels of insulin or insulin resistance.

So what we can see is that insulin seems to act on egg follicular cells to produce more androgens.

And androgens themselves are also associated with worsening insulin resistance.

So this is a type of cycle or feedback mechanism.

And these high androgen levels are going to end up leading to alterations in gonadotropin levels.

Gonadotropins are hormones that are produced in the brain.

So we've got follicle-stimulating hormone and luteinizing hormone from the pituitary gland.

They have to be at certain levels at certain times, and if they're not, then we can have issues with the menstrual cycle and issues specifically with ovulation.

So these altered gonadotropin levels are going to lead to issues with ovulation.

That's going to be key in PCOS, so we can either have cessation of menstruation or your period, so you have no period at all, or you could have fewer periods than normal.

So you might have a period once every few months, for instance.

So that's going to be one of the key criteria for diagnosing PCOS.

The other ones are ultrasound findings of cysts in the ovaries or signs and symptoms of hyperandrogenism.

So we're going to discuss especially some of those key findings we can see of hyperandrogenism in this lesson.

And we'll also see that insulin resistance can also cause skin findings as well.

Now one of the skin findings that can occur in PCOS patients is what we call acanthosis nigricans.

So acanthosis nigricans is hyperpigmented thickened velvety skin lesions.

So it's hyperpigmented meaning that it is darker than the surrounding skin.

It's thickened so it's thicker than the surrounding skin and it's described as having a velvety texture.

It's going to be most often found in what we call the intertriginous areas where skin rubs on skin so in the armpits and the groin we can also see it in the neck as well it's going to be symmetrical if you have it in one armpit you're often going to have it in the other armpit it's asymptomatic meaning that it's visible it's seen but it doesn't really cause pain for instance and this is going to be due to insulin resistance now why does this particular finding happen in insulin resistance and in pcos so we know that insulin resistance is associated with pcos so we're going to have higher levels of insulin than is appropriate.

And what we're going to see is that keratinocytes, these are cells that make up the skin, or dermal fibroblasts, they themselves have a receptor known as insulin-like growth factor receptor 1 or IGFR1, which gets stimulated by insulin.

So if you have higher levels of insulin, we're going to have activation of IGFR1, which is going to stimulate dermal fibroblasts to create more skin cells.

So we end up getting more of these skin cells.

So this is the reason why we can get this thickened and hyperpigmented skin lesion in not only insulin resistance, but PCOS because PCOS has insulin resistance.

Now we can also see alopecia in some patients with PCOS as well.

So alopecia is going to be hair loss or hair thinning.

This is going to be due to increased androgen levels.

So that's going to be one of the signs of hyperandrogenism.

And why does this happen?

Well, if we're looking at this diagram here, here is the hair follicle and androgens act on hair follicles differently depending on where the hair follicle is located.

So if it's on your scalp, androgens can actually cause a miniaturization of the hair follicle.

So there's hair follicle miniaturization.

So the hair becomes actually shorter and smaller due to exposure to higher levels of androgens, especially either testosterone, but even dihydrotestosterone is a more potent form of testosterone.

So that's going to cause a shrinking of the hair follicle.

This why we can see either hair loss or hair thinning.

And we can often see this, especially in female patients, in the part line of their hair.

And they could have some receding as well.

So we can see it right in the part line.

And if this is left untreated, if they have more severe alopecia, they can have quite a bit of hair loss in that part line of their hair.

Another finding is acne.

So acne is also due to increased androgen levels.

This is another sign of hyperandrogenism.

So if you didn't have the alopecia but you had the acne, that's also enough to say that this patient has a sign of hyperandrogenism that would help with the diagnosis.

And this is going to be specifically due to increased sebum production.

So we come back to this diagram again.

Androgens are going to act not only on the hair follicle we just mentioned, but it can also act on the sebaceous gland.

The sebaceous gland produces sebum, and that sebum is going to be that skin oil, and what is going to occur is that we're going to have increased production of sebum, and the sebum that's produced, especially when there's higher levels of androgens, is it's going to be more sebum and thicker sebum, so we can end up getting blockage of the pore that surrounds the hair follicle and we can end up getting acne because of it.

So this is going to be a reason why we can see acne in patients with PCOS as well.

Another finding is hirsutism.

So hirsutism is excessive hair growth.

This is also again due to increased androgen levels.

So those three findings we just talked about, alopecia, acne, and hirsutism, are all potential findings that clinicians will look for when they're trying to make a diagnosis of PCOS.

So again we talked about those three.

Diagnostic criteria, issues or changes in ovulation patterns, so changes in your menstruation patterns, either no menstruation or infrequent menstruation, ultrasound findings of cysts in the ovary, and then the third is signs and symptoms of hyperandrogenism.

And we just talked about three findings that are enough to say that that patient is showing signs of hyperandrogenism.

Again, alopecia, acne, and hirsutism.

Now we did talk about the fact that higher androgen levels can affect hair follicles differently depending on what part of the body they are found on.

If they're on the scalp again, they're more likely to cause miniaturization of the follicle.

Whereas in other parts of the body, like the face and also the chest and the back, this is going to be particularly important with regards to hirsutism, we can see more hair growth than is normal.

And what is more specifically happening in these cases is that the androgens themselves are changing fine velous hair into darker and thicker terminal hair.

So it's a change between one type of hair to the other.

Those androgens are affecting or changing one type of hair into the other and again on particular parts of the body like the face, the chest, and the back.

Please check out my other lessons on PCOS if you want more information on how it's diagnosed and treated.

Please also consider joining us a member for members-only content.

If you haven't already, please like and subscribe for more lessons like this one.

And as always, thanks so much for watching and hope to see you again soon.

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Pratica di Shadowing: PCOS & Your Skin: 4 Signs Your Hormones Are Out of Control - Impara a parlare inglese con YouTube

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