ACNE
Acne is one of the cutaneous manifestations of PCOS, around 85% of individuals between 12 and 24 years are reported to have acne (16). Most women with PCOS show facial acne lesions and up to 50% of women affect the neck, chest, and upper back (17). The leading cause of acne is excessive ovarian and/or adrenal androgen secretion (18, 19). Most women with PCOS have high plasma concentrations of androgens (20). Androstenedione and testosterone are markers of ovarian androgen secretion (21, 22), and dehydroepiandrosterone sulfate is the indicator of adrenal secretion (23). The insulin resistance and hyperinsulinemia appear to be a significant factor in triggering hyperandrogenaemia, acting directly to produce excessive androgen by ovarian theca cells (24). Androgens results in overproduction of the sebum causing abnormal keratinization resulting in comedones formation (25). Additional colonization of the follicles by Propionibacterium acnes (P acne) leads to inflammation and later formation of papules, pustules, nodules, cysts, and scarring (26). Acne formation is likely more dependent on local androgen concentrations and sensitivity of androgen receptors on the sebaceous glands to androgens, which is independent of circulating levels (27, 28).