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• Density of the hair follicles

Up to 70% of women with PCOS are hirsute and exhibit increased or excessive facial and body hair in a pattern of male distribution. Because of the elevated androgen levels, the growth phase of the hair cycle is prolonged which results in increased hair. It is most noticeable on women with dark hair. Although hair growth follows a male pattern due to the hyperandrogenism, virilization (masculine features) is not commonly found in women with PCOS and if present, it is usually mild.

Hirsutism is a considerable source of embarrassment for many women, especially for adolescents. Polycystic ovary syndrome is the leading cause of hirsutism in adolescents.

Acne/Seborrhea

Increased androgens also stimulate sebaceous (oil) gland cells which results in increased production of skin oils and dead skin cells. This combination blocks the pores and allows bacteria to multiply and cause inflammation. In hyperandrogen-related acne, women often experience severe, persistent, cystic eruptions. Some studies estimate that up to 35% of women with PCOS suffer from acne. More than one third of women who seek dermatological treatment for acne have PCOS. Polycystic ovary syndrome is also associated with seborrhea, which is flaking skin from the scalp caused by excessive oil.

Alopecia

Some women with PCOS develop alopecia, which is thinning of the hair at the top of the head. It is often called 'male pattern baldness'. It is not seen as often at the temples as it is on the head.

Insulin Resistance and Hyperinsulinemia

As discussed above, insulin resistance and hyperinsulinemia seem to be at the core of PCOS and are related directly or indirectly to almost all of the symptoms.

Acanthosis Nigricans

A sign of hyperinsulinemia is the development of a skin condition called acanthosis nigricans (AN). This appears as velvety, hyperpigmented, warty skin on the nape of the neck, in the armpits, under the breasts, in the vulva, and in other body folds. Persons with AN are at risk for the development of severe insulin resistance, dyslipidemia, non-insulin dependent diabetes mellitus, and hypertension. Prepubertal girls with AN and premature adrenarche have significantly reduced insulin sensitivity.

Dyslipidemia

Dyslipidemia may be associated with PCOS in some women and is characterized by elevated LDL, reduced HDL and elevated triglycerides.

Obstructive Sleep Apnea Syndrome

A study published in 2001 in the Journal of Clinical Endocrinology and Metabolism reported that women with PCOS are at increased risk for obstructive sleep apnea syndrome (OSAS) and excessive daytime sleepiness (EDS). The authors of this study suggested that insulin resistance may be an important risk factor in women with PCOS for developing OSAS and EDS. A separate study in the same medical journal reported that obese women with PCOS are also at increased risk for developing OSAS as compared to age and weight-matched women without PCOS.