Middle East Fertility Society Journal Middle East Fertility Society ISSN: 1110-5690 Vol. 9, Num. 2, 2004, pp. 136-139

Middle East Fertility Society Journal, Vol. 9, No. 2, 2004, pp. 136-139

Acanthosis nigricans as skin manifestation of polycystic ovaries syndrome in primary infertile females

Khalifa E. Sharquie, M.B.Ch.B., Ph.D.^*,Ansma Al-Bayatti, M.B.Ch.B., Ph.D., D.D.V.^†,Awatif J. Al-Bahar, M.B.Ch.B., F.A.H.K.A.R.T.^‡,Qais M. A. Al-Zaidi, M.B.Ch.B.^*

Departments of Dermatology and Venereology, and Biochemistry, College of Medicine, University of Baghdad, Baghdad, Iraq

^* Department of Dermatologyh and Venereology, College of Medicine, University of Baghdad.
^† Department of Biochemistry, College of Medicine, University of Baghdad.
^‡Al-Wasal Hospital, Dubai, UAE

Correspondence: Ansam A. Al-Bayatti, M.B.Ch.B., Ph.D., D.D.V. Assist. Professor and chairman of Biochemistry Department, College of Medicine, University of Baghdad, postal code number 12114, Medical collection post office, Baghdad, Iraq. Tel: 00 964 1 5560036, Fax: 0047 24136110. E-mail: ansimalaad@yahoo.com

Received on December 15, 2003;
revised and accepted on March 1, 2004

Code Number: mf04024

ABSTRACT

Objective: The present work is to record the frequency of Acanthosis Nigricans (AN) among patients with Polycystic Ovaries Syndrome (PCOS), and to observe the frequency of PCOS among patients with AN. and to study the association between AN & PCOS
Materials and methods: The present study consisted of two groups of patients; the first group included thirty-two primary infertile females. Their ages ranged from 18-33 years with a mean ± SD of 25.8 ± 7.2.  The second group included twenty unmarried females with benign AN. Their ages ranged from 16-48 years with a mean ± SD of 18.55±3.73. 15 (75%). All patients are assessed by clinical examination, sonar and hormonal profile. The diagnosis of AN is mainly clinical by observation of hyperpigmented verrucous plagues with a velvety texture symmetrically distributed in the intertriginous areas and oral and anogenital mucosa. The diagnosis was confirmed by histopathological examination.
Results: The first group with primary infertility and PCOS. had AN. In 68.75%, while the second unmarried group who are complaining from AN. Showed the features of PCOS. in 75% of patients
Conclusion: This study showed a close association between PCOS and AN. So AN should be considered as an important skin marker and major feature of PCOS

Key word: Acanthosis Nigricans, Polycytic Ovaries Syndrome, Primary Infertility

Acanthosis Nigrcians (AN) is not an uncommon dermatological problem. Its etiology is still unknown, so called idiopathic but there are many associated abnormalities that could be seen like hormonal changes and malignancies (1-3).

The diagnosis of this problem is mainly clinical by observation of hyperpigmented verrucous plagues with a velvety texture symmetrically distributed in the intertriginous areas including the neck, axilla, groin and umbilicus, and occasionally it may involve the oral and anogenital mucosa (1).

Polycystic ovaries syndrome (PCOS) characterized by obesity, infertility, acne, hirsutism, amenorrhea or oligomenorrhoea, raised LH/FSH ratio of more than 2:1 and PCO by ultrasonography (2,5,6).

The aim of the present work was to record the frequency of AN among patients with Polycystic Ovaries Syndrome (PCOS) and to observe the frequency of PCOS among patients with AN.

MATERIALS AND METHODS

This study included two groups of patients in addition to apparently 15 fertile healthy females as a control.

The first group consisted of thirty-two females with primary infertility and PCOS. Full history was done for all patients concentrating on the following criteria: obesity (Body Mass Index (BMI) equal to or more than 30 were considered to be obese) (7), infertility, acne, hirsutism, and oligo or amenorrhea.

A thorough physical examination was done for all patients. Also, hormonal profile including Follicular Stimulating Hormone(FSH), Leutinizing Hormone(LH), LH/FSH (ratio during early follicular phase), testosterone, progesterone (during mid luteal phase), estradiol (during mid luteal phase), and prolactin. Abdominal and pelvic ultrasonography was done for all patients. The diagnosis of PCOS was done by demonstration of 3 or more of the following criteria: (obesity, infertility, acne, hirsutism, oligomenorrhea or amenorrhea, LH/FSH ratio of more than 2:1, elevated or normal testosterone level, normal or mildly elevated prolactin level, and consistent ultrasonographic changes of PCO).  The necks and axillae of these patients were screened for AN.

The second group consisted of twenty unmarried females presented with AN. The diagnosis of AN was done clinically and confirmed by histopathological examination. These patients were screened for clinical features of PCOS. Furthermore, hormonal profile (LH, FSH, LH/FSH ratio, prolactin and testosterone levels) and ultrasonography were done for these patients. 

RESULTS

The first group: this group included 32 primary infertile females with PCOS. Their ages ranged from 18-33 years with a mean ± SD of 25.8 ±7.2.

Hormonal profile showed that the ratio of LH/FSH was greater than 2:1 with low progesterone level (Table 1). Ultrasonography showed changes of PCOS.

AN of the necks and axillae was noticed in 22(68.75%) of patients.

The second group: this group included 20 unmarried females with benign AN. Their ages ranged from 16-48 years with a mean ± SD of 18.55 ± 3.73. Fifteen patients (75%) had more than 3 criteria of PCOS. Obesity (as measured by BMI) was seen in 13 (65%) of patients, hirsutism was recorded in 12 (60%) of patients, menstrual irregularities (oligomenorrhea or amenorrhea) were reported in 10(50%) of patients, and acne was noticed in 7 (35%) of patients. Ultrasonography with features of PCO was reported in 11 (55%) of patients. Regarding the hormonal profile; thirteen patients (65%) sowed high testosterone level, 8(40%) of patients showed LH/FSH ratio of more than 2:1, and 9 (45%) of patient had high prolactin level (Table 2).

DISCUSSION

The incidence and prevalence of AN in the general population is not yet known (6, 7). Also, its actual incidence among Iraqi people is not studied but AN seems to be not uncommon problem.

AN is classified into hereditary benign AN, syndromic AN (associated with insulin resistance), pseudo-AN (obesity- related), drug-induced AN (nicotinic acid, estrogen and steroids), and malignant AN (Adencarcinoma of the stomach and Lymphoma) (4, 8-11).

PCOS is a very common problem among Iraqi females but unfortunately the association with AN was not recognized before.

In the present work, AN was observed in 68.75% of patients with PCOS and this is a very surprising figure and may confirm a close association between the two conditions.

The association of PCOS with AN is well recognized in many countries (12). Similarly this association was shown in this study as it was noticed in 75% of patients with AN, but this figure is very high when compared to other countries (11).

AN might precede the other features of PCOS and could be an alarming sign of this condition.

So, in conclusion, the present work had shown a significant association of AN with PCOS and AN should be considered as an important skin marker and a major feature of PCOS.

REFERENCES

1. Curth HO, Aschner BM. Genetic studies on AN. Arch Dermatol 1959; 79: 55.
2. Curth HO. Cancer associated with AN: Review of literature and report of a case of AN with cancer of the breast. Arch Surg 1943; 47: 517.
3. Khan CR. flier JS, Bar RS. The syndrom of insulin resistance and A canthosis Nigricans, insuline receptors disorders in man. New Engl J Med 1976; 294: 739 -45.
4. Goldzieher JW. Polycystic ovarian disease. Fertil Steril 1981;35: 37.
5. Edwards CRW, Toft AD, Walker BR. Endocrine diseases. In: Haslett C, Chilvers ER, Hunter JAA, and Boon NA( eds.) Davidson's Principles and Practice of Medicine 8th edition. UK. Chapter 8; p.526.
6. Stuart CA, Hud JA. Prevalence of AN in unselected population. Am J Med 1989; 87: 269.
7. Hud JA. Prevalence and significance of acanthosis nigricans in an adult obese population. Arch Dermatol 1992; 128: 941.
8. Feingold KR, Elias PM. Endocrine-skin interaction. J Am Acad Dermatol 1988; 19: 1-20.
9. Ober KP. AN and insulin resistance associated with hypothyroidism. Arch Dermatol 1985; 121: 229-31.
10. Curth HO. Benign type of Acanthosis Nigricans: etiology. Arch Dermatol 1936; 34: 353.
11. Rendon MI ,Cruz PD, sontheimer RD et al. Acanthosis nigricans acutaneous marker of Tissue resistance to insuline . J Am Acad Dermatol 1989; 21: 461-9.
12. Givens JR, Kerber IJ, Wiser WL. Remission of acanthosis nigricans associated with polycystic ovarian disease and stromal luteoma. J Clin Endocrinol Metabol 1974; 38: 347-55.

© Copyright 2004 - Middle East Fertility Society

The following images related to this document are available:

Photo images