DOI: http://dx.doi.org/10.18203/issn.2455-4529.IntJResDermatol20212548

Predictors of insulin resistance among women with acne vulgaris and polycystic ovarian syndrome presenting to a tertiary care hospital in North India

Mini Chandra, Koshinder Vats, Palak Garg, Abhishek Tibrewal

Abstract


Background: Acne vulgaris is now being increasingly associated with hyperandrogenism or metabolic syndrome. The aim of the study was to know the burden and determinants of insulin resistance among females suffering from acne and polycystic ovarian syndrome (PCOS).

Methods: This prospective observational study included non-pregnant females with acne and PCOS aged 14 to 36 years. PCOS was diagnosed using Rotterdam criteria. Insulin resistance (IR) was confirmed using HOMA-IR values. Important history was ascertained, and hormonal essays were done. SPSS version 22 was used for the analyses.

Results: The average age of the 81 subjects was 22 (IQR: 19-23) years and median duration of acne was 8 (7-9) months. Their median (IQR) insulin level was 10.5 (8.4 - 18.5), fasting blood glucose was 82 (73.2 - 90) and HOMA-IR value was 2 (1.7 - 3.9). A total of 27 (33.3%) were diagnosed with IR. Subjects having IR had significantly lower FSH (median=3.1, IQR: 2.3-6.3), LH (3.0, 1.2-3.3) and insulin level (median=26.0, 18.5-28.5) versus those without IR (p=0.04, p=0.04 and p<0.001 respectively). Subjects with IR were more likely to be having irregular menses, weight gain, and acanthosis nigricans versus those without IR.  

Conclusions: One-third of the patients with acne and PCOS also had IR according to the HOMA-IR values. All women with acne and PCOS should be considered for underlying IR and examined for other sign of impaired glucose tolerance.


Keywords


Acne vulgaris, PCOS, Insulin resistance, HOMA-IR, India

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References


Heng AHS, Chew FT. Systematic review of the epidemiology of acne vulgaris. Sci Rep. 2020;10(1):5754.

Lyon CC. Acne: Diagnosis and Management. J R Soc Med. 2001;94(12):652.

Balachandrudu B, Niveditadevi V, Rani TP. Hormonal Pathogenesis of Acne- Simplified. Int J Sci Stud. 2015;3:183-5.

Melnik BC, John SM, Plewig G. Acne: risk indicator for increased body mass index and insulin resistance. Acta Derm Venereol. 2013;93(6):644-9.

Smith TM, Gilliland K, Clawson GA, Thiboutot D. IGF-1 induces SREBP-1 expression and lipogenesis in SEB-1 sebocytes via activation of the phosphoinositide 3-kinase/Akt pathway. J Invest Dermatol. 2008;128(5):1286-93.

Kahn CR, Flier JS, Bar RS, Archer JA, Gorden P, Martin MM, et al. The syndromes of insulin resistance and acanthosis nigricans. Insulin-receptor disorders in man. N Engl J Med. 1976;294(14):739-45.

Goldzieher J. Historical perspectives. In: Chang RJ, Heindel J, Dunaif A, eds. Polycystic ovary syndrome. New York: Marcel Dekker; 2002: 1-14.

Goldzieher JW, Green JA. The polycystic ovary- Clinical and histologic features. J Clin Endocrinol Metab. 1962;22:325-38.

Burghen GA, Givens JR, Kitabchi AE. Correlation of hyperandrogenism with hyperinsulinism in polycystic ovarian disease. J Clin Endocrinol Metab. 1980;50(1):113-6.

Dunaif A, Hoffman AR, Scully RE, Flier JS, Longcope C, Levy LJ, et al. Clinical, biochemical, and ovarian morphologic features in women with acanthosis nigricans and masculinization. Obstet Gynecol. 1985;66(4):545-52.

Flier JS, Eastman RC, Minaker KL, Matteson D, Rowe JW. Acanthosis nigricans in obese women with hyperandrogenism. Characterization of an insulin-resistant state distinct from the type A and B syndromes. Diabetes. 1985;34(2):101-7.

Donald PC, Rombaut RP, Siiteri PK. Plasma precursors of estrogen. I. Extent of conversion of plasma delta-4-androstenedione to estrone in normal males and nonpregnant normal, castrate and adrenalectomized females. J Clin Endocrinol Metab. 1967;27(8):1103-11.

Roumain J, Charles MA, Courten MP, Hanson RL, Brodie TD, Pettitt DJ, Knowler WC. The relationship of menstrual irregularity to type 2 diabetes in Pima Indian women. Diabetes Care. 1998;21(3):346-9.

Solomon CG, Hu FB, Dunaif A, Rich EJ, Willett WC, Hunter DJ, et al. Long or highly irregular menstrual cycles as a marker for risk of type 2 diabetes mellitus. JAMA. 2001;286(19):2421-6.

Napolitano M, Megna M, Monfrecola G. Insulin resistance and skin diseases. Scientific World J. 2015;479354.

Wild RA. Long-term health consequences of PCOS. Hum Reprod Update. 2002;8(3):231-41.

Macut D, Bjekic MJ, Rahelic D, Doknic M. Insulin and the polycystic ovary syndrome. Diabetes Res Clin Pract. 2017;130:163‐70.

Toprak S, Yonem A, Cakir B, Guler S, Azal O, Ozata M, et al. Insulin resistance in nonobese patients with polycystic ovary syndrome. Horm Res. 2001;55(2):65-70.

Futterweit W, Dunaif A, Yeh HC, Kingsley P. The prevalence of hyperandrogenism in 109 consecutive female patients with diffuse alopecia. J Am Acad Dermatol. 1988;19(5):831-6.

Conway GS, Honour JW, Jacobs HS. Heterogeneity of the polycystic ovary syndrome: clinical, endocrine and ultrasound features in 556 patients. Clin Endocrinol. 1989;30(4):459-70.

Driscoll JB, Mamtora H, Higginson J, Pollock A, Kane J, Anderson DC. 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. 1994;41(2):231-6.

Garg MK, Tandon N, Marwaha RK, Singh Y. Evaluation of surrogate markers for insulin resistance for defining metabolic syndrome in urban Indian adolescents. Indian Pediatr. 2014;51:279-84.

Panag KM, Kaur N, Goyal G. Correlation of insulin resistance by various methods with fasting insulin in obese. Int J Appl Basic Med Res. 2014;4:41-5.

Rotterdam ESHRE/ASRM- Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004;19(1):41-7.

Li W, Chen Q, Xie Y, Hu J, Yang S, Lin M. Prevalence and degree of insulin resistance in Chinese Han women with PCOS: Results from euglycemic-hyperinsulinemic clamps. Clin Endocrinol. 2019;90(1):138-44.

Lai JJ, Chang P, Lai KP, Chen L, Chang C. The role of androgen and androgen receptor in skin-related disorders. Arch Dermatol Res. 2012;304(7):499-510.

Bettoli V, Zauli S, Virgili A. Is hormonal treatment still an option in acne today?. Br J Dermatol. 2015;172(1):37-46.

Elsaie ML. Hormonal treatment of acne vulgaris: an update. Clin Cosmet Investig Dermatol. 2016;9:241-8.

Nawrocka RJ, Ciecwiez S, Marciniak A, Brodowska A, Wisniewska B, Kotlega D, et al. Insulin resistance assessment in patients with polycystic ovary syndrome using different diagnostic criteria--impact of metformin treatment. Ann Agric Environ Med. 2013;20(3):528-32.

Tabassum R, Imtiaz F, Sharafat S, Shukar DS, Nusrat U. Prevalence and clinical profile of insulin resistance in young women of poly cystic ovary syndrome: A study from Pakistan. Pak J Med Sci. 2013;29:593‐6.

Ugarte CM, Bartolucci AA, Azziz R. Prevalence of insulin resistance in the polycystic ovary syndrome using the homeostasis model assessment. Fertil Steril. 2005;83(5):1454-60.

Dunaif A. Insulin resistance and polycystic ovarian syndrome: Mechanism and implications for pathogenesis. Endocr Rev. 1997;18(6):774-800.

Vrbikova J, Dovrakova K. Prevalence of insulin resistance and prediction of glucose intolerance and type 2 diabetes mellitus in women with polycystic ovarian syndrome. Clin Chem Lab Med. 2007;45(5):639-44.

Kalra A, Nair S, Rai L. Association of obesity and insulin resistance with dyslipidemia in Indian women with polycystic ovarian syndrome. Ind J Med Sci. 2006;60(11):447-53.

Sidra S, Tariq MH, Farrukh MJ, Mohsin M (2019) Evaluation of clinical manifestations, health risks, and quality of life among women with polycystic ovary syndrome. PLoS ONE 14(10):e0223329.

Wongwananuruk T, Rattanachaiyanont M, Indhavivadhana S, Leerasiri P, Techatraisak K, Tanmahasamut P, et al. Prevalence and clinical predictor of insulin resistance in reproductive aged Thai women with polycystic ovarian syndrome. Int J Endocrinol. 2012;6.

Tosi F, Bonora E, Moghetti P. Insulin resistance in a large cohort of women with polycystic ovary syndrome: a comparison between euglycaemic‐hyperinsulinaemic clamp and surrogate indexes. Hum Reprod. 2017;32:2515‐21.

Mehta AS. Clinical, Biochemical, and Hormonal Associations in Female Patients with Acne: A Study and Literature Review. J Clin Aesthet Dermatol. 2017;10(10):18-24.

Emiroglu N, Cengiz FP, Kemeriz F. Insulin resistance in severe acne vulgaris. Postepy Dermatol Alergol. 2015;32(4):281-5.

Agarwal N, Gangopadhyay S, Koch N, Gupta A, Batra A, Kabi BC. Int J Res Med Sci. 2015;3(6):1321-4.

Marsden PJ, Murdoch A, Taylor R. Severe impairment of insulin action in adipocytes from amenorrheic subjects with polycystic ovary syndrome. Metabolism. 1994;43(12):1536-42.

Azziz R. Controversy in clinical endocrinology: diagnosis of polycystic ovarian syndrome: the Rotterdam criteria are premature. J Clin Endocrinol Metab. 2006;91(3):781-5.

Ehrmann DA, Liljenquist DR, Kasza K, Azziz R, Legro RS, Ghazzi MN. Prevalence and predictors of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2006;91(1):48-53.

Dasgupta A, Khan A, Banerjee U, Ghosh M, Pal M, Chaudhary KM, et al. Predictors of insulin resistance and metabolic complications in polycystic ovarian syndrome in an eastern Indian population. Indian J Clin Biochem. 2013;28(2):169-76.

Baptiste CG, Battista MC, Trottier A, Baillargeon JP. Insulin and hyperandrogenism in women with polycystic ovary syndrome. J Steroid Biochem Mol Biol. 2010;122(1):42-52.

Ebede TL, Arch EL, Berson D. Hormonal treatment of acne in women. J Clin Aesthet Dermatol. 2009;2(12):16-22.