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Metformin Therapy for Acne in Patients with Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis

Abstract

Background

Acne is one of the cutaneous manifestations of polycystic ovary syndrome (PCOS). There is limited evidence on metformin use for treatment of acne in PCOS patients.

Objective

Our aim was to conduct a systematic review and meta-analysis to evaluate the efficacy of metformin for treatment of PCOS-related acne.

Methods

On November 23, 2019, we searched PubMed, the Cochrane Library, and Embase databases for human clinical studies in any language. The keywords included ‘acne’ and ‘polycystic ovary syndrome’ combined with ‘metformin,’ ‘biguanide,’ or ‘glucophage.’ We included randomized controlled trials (RCTs), non-randomized controlled trials (NRCTs), and open-label studies on patients with PCOS treated with metformin. We calculated standardized mean differences (SMDs) for acne scores and odds ratios (ORs) for presence of acne, with 95% confidence intervals (CIs). Quality assessment was performed using the Cochrane Collaboration risk of bias instrument for RCTs. NRCTs and open-label studies were assessed using the adapted methodological index for nonrandomized studies (MINORS).

Results

We included 51 studies on 2405 PCOS patients. Metformin as adjuvant therapy led to greater improvement of acne scores than the same therapy without metformin (SMD − 0.256; 95% CI − 0.439 to − 0.074). Pooling pre- and post-metformin therapy data showed significant decrease of acne scores after metformin use (SMD − 0.712; 95% CI − 0.949 to − 0.476). Presence of acne decreased significantly after metformin treatment (OR 0.362; 95% CI 0.271 to 0.485).

Limitations

There was heterogeneity across some studies due to different acne assessment scales, metformin dosages, and treatment durations.

Conclusions

For PCOS patients, metformin as stand-alone or adjuvant therapy was associated with improvement of acne. More randomized controlled trials are needed to validate these results.

Registration

PROSPERO registration number CRD42020159656.

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References

  1. 1.

    Bozdag G, Mumusoglu S, Zengin D, Karabulut E, Yildiz BO. The prevalence and phenotypic features of polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod. 2016;31:2841–55.

    PubMed  Google Scholar 

  2. 2.

    Zawadski JK. Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. In: Dunaif A, Haseltine FP, Merriam GR, editors. Polycystic ovary syndrome. Boston: Blackwell Scientific; 1992. p. 377–384.

    Google Scholar 

  3. 3.

    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;19:41–7.

    Google Scholar 

  4. 4.

    Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, et al. Positions statement: criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an androgen excess society guideline. J Clin Endocrinol Metab. 2006;91:4237–45.

    CAS  PubMed  Google Scholar 

  5. 5.

    Carmina E. Cutaneous manifestations of polycystic ovary syndrome. Curr Opin Endocr Metab Res. 2020;12:49–52.

    Google Scholar 

  6. 6.

    Altinok ML, Ravn P, Andersen M, Glintborg D. Effect of 12-month treatment with metformin and/or oral contraceptives on health-related quality of life in polycystic ovary syndrome. Gynecol Endocrinol. 2018;34:859–63.

    CAS  PubMed  Google Scholar 

  7. 7.

    Rocha MA, Bagatin E. Skin barrier and microbiome in acne. Arch Dermatol Res. 2018;310:181–5.

    CAS  PubMed  Google Scholar 

  8. 8.

    Clayton RW, Gobel K, Niessen CM, Paus R, van Steensel MAM, Lim X. Homeostasis of the sebaceous gland and mechanisms of acne pathogenesis. Br J Dermatol. 2019;181:677–90.

    CAS  PubMed  Google Scholar 

  9. 9.

    Kumar B, Pathak R, Mary PB, Jha D, Sardana K, Gautam HK. New insights into acne pathogenesis: exploring the role of acne-associated microbial populations. Dermatologica Sinica. 2016;34:67–73.

    Google Scholar 

  10. 10.

    Bubna A. Metformin—for the dermatologist. Indian J Pharmacol. 2016;48:4–10.

    CAS  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Behrangi E, Sadeghi S, Sadeghzadeh-Bazargan A, Goodarzi A, Ghassemi M, Sepasgozar S, et al. The effect of metformin in the treatment of intractable and late onset acne: a comparison with oral isotretinoin. Iran J Dermatol. 2019;22:47–52.

    Google Scholar 

  12. 12.

    Hafez M, Musa N, Elbehairy S, Atty SA, Elbarbary M, Amin M. Effect of metformin on clinical and biochemical hyperandrogenism in adolescent girls with type 1 diabetes. J Pediatr Endocrinol Metab. 2019;32:461–70.

    CAS  PubMed  Google Scholar 

  13. 13.

    Foda AA, Foda EA, El-Negeri MA, El-Said ZH. Serum chemerin levels in polycystic ovary syndrome after metformin therapy. Diabetes Metab Syndr Clin Res Rev. 2019;13:1309–15.

    Google Scholar 

  14. 14.

    Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9.

    PubMed  Google Scholar 

  15. 15.

    Abrams KR, Gillies CL, Lambert PC. Meta-analysis of heterogeneously reported trials assessing change from baseline. Stat Med. 2005;24:3823–44.

    PubMed  Google Scholar 

  16. 16.

    Zou GY. One relative risk versus two odds ratios: implications for meta-analyses involving paired and unpaired binary data. Clin Trials. 2007;4:25–31.

    PubMed  Google Scholar 

  17. 17.

    Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–58.

    PubMed  PubMed Central  Google Scholar 

  18. 18.

    Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–34.

    CAS  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Otta CF, Wior M, Iraci GS, Kaplan R, Torres D, Gaido MI, et al. Clinical, metabolic, and endocrine parameters in response to metformin and lifestyle intervention in women with polycystic ovary syndrome: a randomized, double-blind, and placebo control trial. Gynecol Endocrinol. 2010;26:173–8.

    CAS  Google Scholar 

  20. 20.

    Ladson G, Dodson WC, Sweet SD, Archibong AE, Kunselman AR, Demers LM, et al. Effects of metformin in adolescents with polycystic ovary syndrome undertaking lifestyle therapy: a pilot randomized double-blind study. Fertil Steril. 2011;95(2595–8):e6.

    Google Scholar 

  21. 21.

    Ladson G, Dodson WC, Sweet SD, Archibong AE, Kunselman AR, Demers LM, et al. The effects of metformin with lifestyle therapy in polycystic ovary syndrome: a randomized double-blind study. Fertil Steril. 2011;95(1059–66):e7.

    Google Scholar 

  22. 22.

    Tiwari N, Pasrija S, Jain S. Randomised controlled trial to study the efficacy of exercise with and without metformin on women with polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol. 2019;234:149–54.

    CAS  PubMed  Google Scholar 

  23. 23.

    Harborne L, Fleming R, Lyall H, Sattar N, Norman J. Metformin or antiandrogen in the treatment of hirsutism in polycystic ovary syndrome. J Clin Endocrinol Metab. 2003;88:4116–233.

    CAS  PubMed  Google Scholar 

  24. 24.

    Allen HF, Mazzoni C, Heptulla RA, Murray MA, Miller N, Koenigs L, et al. Randomized controlled trial evaluating response to metformin versus standard therapy in the treatment of adolescents with polycystic ovary syndrome. J Pediatr Endocrinol Metab. 2005;18:761–8.

    CAS  PubMed  Google Scholar 

  25. 25.

    Petrányi G, Zaoura M. Five-year treatment experience with metformin in polycystic ovary syndrome. In: 9th European congress of endocrinology. Budapest, Hungary: Endocrine Abstracts; 2007, p. P493.

  26. 26.

    Ubertini G, Menghi I, Grossi A, Carducci C, Benevento D, Fiori R, et al. Polycystic ovary syndrome treatment during adolescence: Improvement of clinical and metabolic parameters with metformin versus oestroprogestins and antiandrogens. Horm Res Paediatr. 2013;80(suppl 1):238.

    Google Scholar 

  27. 27.

    Iwata MC, Porquere L, Espósito Sorpreso IC, Baracat EC, Júnior JMS. Association of oral contraceptive and metformin did not improve insulin resistance in women with polycystic ovary syndrome. Rev Assoc Med Bras. 2015;61:215–9.

    PubMed  Google Scholar 

  28. 28.

    Wu H, Ruan X, Jin J, Mueck AO. Metabolic profile of Diane-35 versus Diane-35 plus metformin in Chinese PCOS women under standardized life-style changes. Gynecol Endocrinol. 2015;31:548–51.

    CAS  PubMed  Google Scholar 

  29. 29.

    Bhattacharya SM, Biswas B, Basu A. Comparative study of the therapeutic effects of drospirenone (DRSP, 3 mg) with ethinyl estradiol (EE, 20 MCG) pill with or without metformin 500 mg in polycystic ovary syndrome (PCOS). Fertil Steril. 2016;106:e257.

    Google Scholar 

  30. 30.

    Feng W, Jia YY, Zhang DY, Shi HR. Management of polycystic ovarian syndrome with Diane-35 or Diane-35 plus metformin. Gynecol Endocrinol. 2016;32:147–50.

    PubMed  Google Scholar 

  31. 31.

    Mhao NS, Al-Hilli ASA, Hadi NR, Jamil DA, Al-Aubaidy HA. A comparative study to illustrate the benefits of using ethinyl estradiol-cyproterone acetate over metformin in patients with polycystic ovarian syndrome. Diabetes Metab Syndr Clin Res Rev. 2016;10:S95–S9898.

    Google Scholar 

  32. 32.

    Kumar Y, Kotwal N, Singh Y, Upreti V, Somani S, Hari Kumar KVS. A randomized, controlled trial comparing the metformin, oral contraceptive pills and their combination in patients with polycystic ovarian syndrome. J Family Med Prim Care. 2018;7:551–6.

    PubMed  PubMed Central  Google Scholar 

  33. 33.

    Agarwal N, Kumar D, Kriplani A, Kumar A, Bhatla N, Kachhawa G, et al. Effects of myoinositol on clinical, hormonal and metabolic parameters of PCOS in comparison to metformin. Int J Gynecol Obstet. 2015;131(S5):E572.

    Google Scholar 

  34. 34.

    Angik R, Jajoo SS, Hariharan C, Chimote A. A comparative study of metabolic and hormonal effects of myoinositol vs. metformin in women with polycystic ovary syndrome: a randomised controlled trial. Int J Reprod Contracept Obstet Gynecol. 2017;4:6.

    Google Scholar 

  35. 35.

    Fruzzetti F, Perini D, Russo M, Bucci F, Gadducci A. Comparison of two insulin sensitizers, metformin and myo-inositol, in women with polycystic ovary syndrome (PCOS). Gynecol Endocrinol. 2017;33:39–42.

    CAS  PubMed  Google Scholar 

  36. 36.

    Bahadur A, Arora H, Chaturvedi J, Raj A, Chawla L, Gaurav A, et al. To compare clinical and metabolic effects of metformin versus combined therapy with metformin and myoinositol and D-chiro-inositol in PCOS women: a randomized control trial. Hum Reprod. 2018;33(supp_1):i461.

    Google Scholar 

  37. 37.

    Chhabra N, Malik S. Effect of insulin sensitizers on raised serum anti-mullerian hormone levels in infertile women with polycystic ovarian syndrome. J Hum Reprod Sci. 2018;11:348–52.

    CAS  PubMed  PubMed Central  Google Scholar 

  38. 38.

    Banaszewska B, Pawelczyk L, Spaczynski RZ, Duleba AJ. Effects of simvastatin and metformin on polycystic ovary syndrome after six months of treatment. J Clin Endocrinol Metab. 2011;96:3493–501.

    CAS  PubMed  PubMed Central  Google Scholar 

  39. 39.

    Navali N, Pourabolghasem S, Fouladi RF, Nikpour MA. Therapeutic effects of biguanide vs. statin in polycystic ovary syndrome: a randomized clinical trial. Pak J Biol Sci. 2011;14:658–63.

    CAS  PubMed  Google Scholar 

  40. 40.

    Seyam E, Hefzy E. Long-term effects of combined simvastatin and metformin treatment on the clinical abnormalities and ovulation dysfunction in single young women with polycystic ovary syndrome. Gynecol Endocrinol. 2018;34:1073–80.

    CAS  PubMed  Google Scholar 

  41. 41.

    Shahebrahimi K, Jalilian N, Bazgir N, Rezaei M. Comparison clinical and metabolic effects of metformin and pioglitazone in polycystic ovary syndrome. Indian J Endocrinol Metab. 2016;20:805–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  42. 42.

    Sohrevardi SM, Nosouhi F, Khalilzade SH, Kafaie P, Karimi-Zarchi M, Halvaei I, et al. Evaluating the effect of insulin sensitizers metformin and pioglitazone alone and in combination on women with polycystic ovary syndrome: an RCT. Int J Reprod BioMed. 2016;14:743–54.

    CAS  PubMed  PubMed Central  Google Scholar 

  43. 43.

    Li Y, Tan J, Wang Q, Duan C, Hu Y, Huang W. Comparing the individual effects of metformin and rosiglitazone and their combination in obese women with polycystic ovary syndrome: a randomized controlled trial. Fertil Steril. 2020;113(1):197–204.

    CAS  PubMed  Google Scholar 

  44. 44.

    Tehrani HG, Mostajeran F, Shahsavari S. The effect of calcium and vitamin D supplementation on menstrual cycle, body mass index and hyperandrogenism state of women with poly cystic ovarian syndrome. J Res Med Sci. 2014;19:875–80.

    CAS  PubMed  PubMed Central  Google Scholar 

  45. 45.

    Dravecká I, Figurová J, Javorský M, Petríková J, Vaľková M, Lazúrová I. The effect of alfacalcidiol and metformin on phenotype manifestations in women with polycystic ovary syndrome—a preliminary study. Physiol Res. 2016;65:815–22.

    PubMed  Google Scholar 

  46. 46.

    Kolodziejczyk B, Duleba AJ, Spaczynski RZ, Pawelczyk L. Metformin therapy decreases hyperandrogenism and hyperinsulinemia in women with polycystic ovary syndrome. Fertil Steril. 2000;73:1149–54.

    CAS  PubMed  Google Scholar 

  47. 47.

    Kazerooni T, Dehghan-Kooshkghazi M. Effects of metformin therapy on hyperandrogenism in women with polycystic ovarian syndrome. Gynecol Endocrinol. 2003;17:51–6.

    CAS  PubMed  Google Scholar 

  48. 48.

    Kriplani A, Agarwal N. Effects of metformin on clinical and biochemical parameters in polycystic ovary syndrome. J Reprod Med Obstet Gynecol. 2004;49:361–7.

    CAS  Google Scholar 

  49. 49.

    Petrányi G, Zaoura-Petranyi M. Metformin treatment with or without life style changes in patients with polycystic ovary syndrome. Orv Hetil. 2011;152:628–32.

    PubMed  Google Scholar 

  50. 50.

    Israni DA, Mehta TY, Shah SR, Goyal RK. Effect of metformin therapy in female visiting dermatologist for acne vulgaris having endocrine and sonographic characteristics of polycystic ovary syndrome (PCOS). Asian J Pharm Clin Res. 2013;6(2):76–82.

    CAS  Google Scholar 

  51. 51.

    Sharma S, Mathur DK, Paliwal V, Bhargava P. Efficacy of metformin in the treatment of acne in women with polycystic ovarian syndrome: a newer approach to acne therapy. J Clin Aesthet Dermatol. 2019;12:34–8.

    PubMed  PubMed Central  Google Scholar 

  52. 52.

    Hahn S, Quadbeck B, Elsenbruch S, Gartner R, Finke R, Mann K, et al. Metformin, an efficacious drug in the treatment of polycystic ovary syndrome. Dtsch Med Wochenschr. 2004;129:1059–64.

    CAS  PubMed  Google Scholar 

  53. 53.

    Hahn S, Benson S, Elsenbruch S, Pleger K, Tan S, Mann K, et al. Metformin treatment of polycystic ovary syndrome improves health-related quality-of-life, emotional distress and sexuality. Hum Reprod. 2006;21:1925–34.

    CAS  PubMed  Google Scholar 

  54. 54.

    De Leo V, Musacchio MC, Morgante G, Piomboni P, Petraglia F. Metformin treatment is effective in obese teenage girls with PCOS. Hum Reprod. 2006;21:2252–6.

    PubMed  Google Scholar 

  55. 55.

    Tan S, Hahn S, Benson S, Dietz T, Lahner H, Moeller LC, et al. Metformin improves polycystic ovary syndrome symptoms irrespective of pre-treatment insulin resistance. Eur J Endocrinol. 2007;157:669–76.

    CAS  PubMed  Google Scholar 

  56. 56.

    Nazari T, Bayat R, Hamedi M. Metformin therapy in girls with polycystic ovary syndrome: a self-controlled clinical trial. Arch Iran Med. 2007;10:176–81.

    CAS  PubMed  Google Scholar 

  57. 57.

    Gayatri K, Kumar JS, Kumar BB. Metformin and N-acetyl cysteine in polycystic ovarian syndrome—a comparative study. Indian J Clin Med. 2010;1:7–13.

    Google Scholar 

  58. 58.

    Jaganmohan C, Vannan M, Ali A, Parasuraman S. Evaluation of clinical efficacy of metformin therapy in polycystic ovary syndrome. J Young Pharm. 2017;9:277–9.

    CAS  Google Scholar 

  59. 59.

    Artani M, Iftikhar MF, Khan S. Effects of metformin on symptoms of polycystic ovarian syndrome among women of reproductive age. Cureus. 2018;10:e3203.

    PubMed  PubMed Central  Google Scholar 

  60. 60.

    Witchel SF, Oberfield SE, Peña AS. Polycystic ovary syndrome: pathophysiology, presentation, and treatment with emphasis on adolescent girls. J Endocr Soc. 2019;3:1545–73.

    CAS  PubMed  PubMed Central  Google Scholar 

  61. 61.

    Gilling-Smith C, Willis DS, Beard RW, Franks S. Hypersecretion of androstenedione by isolated thecal cells from polycystic ovaries. J Clin Endocrinol Metab. 1994;79:1158–65.

    CAS  PubMed  Google Scholar 

  62. 62.

    Jayasena CN, Franks S. The management of patients with polycystic ovary syndrome. Nat Rev Endocrinol. 2014;10:624–36.

    PubMed  Google Scholar 

  63. 63.

    Nestler JE, Jakubowicz DJ. Lean women with polycystic ovary syndrome respond to insulin reduction with decreases in ovarian P450c17 alpha activity and serum androgens. J Clin Endocrinol Metab. 1997;82:4075–9.

    CAS  PubMed  Google Scholar 

  64. 64.

    Baskind NE, Balen AH. Hypothalamic-pituitary, ovarian and adrenal contributions to polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol. 2016;37:80–97.

    PubMed  Google Scholar 

  65. 65.

    Stepto NK, Cassar S, Joham AE, Hutchison SK, Harrison CL, Goldstein RF, et al. Women with polycystic ovary syndrome have intrinsic insulin resistance on euglycaemic-hyperinsulaemic clamp. Hum Reprod. 2013;28:777–84.

    CAS  PubMed  Google Scholar 

  66. 66.

    Setji TL, Brown AJ. Polycystic ovary syndrome: update on diagnosis and treatment. Am J Med. 2014;127:912–9.

    PubMed  Google Scholar 

  67. 67.

    Wang T, McNeill AM, Chen Y, Senderak M, Shankar RR. Metformin prescription patterns among US adolescents aged 10–19 years: 2009–2013. J Clin Pharm Ther. 2016;41:229–36.

    PubMed  Google Scholar 

  68. 68.

    Lord JM, Flight IHK, Norman RJ. Metformin in polycystic ovary syndrome: systematic review and meta-analysis. BMJ. 2003;327:951.

    CAS  PubMed  PubMed Central  Google Scholar 

  69. 69.

    Cameron AR, Morrison VL, Levin D, Mohan M, Forteath C, Beall C, et al. Anti-inflammatory effects of metformin irrespective of diabetes status. Circ Res. 2016;119:652–65.

    CAS  PubMed  PubMed Central  Google Scholar 

  70. 70.

    Harborne L, Fleming R, Lyall H, Norman J, Sattar N. Descriptive review of the evidence for the use of metformin in polycystic ovary syndrome. Lancet. 2003;361:1894–901.

    CAS  PubMed  Google Scholar 

  71. 71.

    Domecq JP, Prutsky G, Mullan RJ, Sundaresh V, Wang AT, Erwin PJ, et al. Adverse effects of the common treatments for polycystic ovary syndrome: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2013;98:4646–54.

    CAS  PubMed  PubMed Central  Google Scholar 

  72. 72.

    Sharma ST, Wickham EP 3rd, Nestler JE. Changes in glucose tolerance with metformin treatment in polycystic ovary syndrome: a retrospective analysis. Endocr Pract. 2007;13:373–9.

    PubMed  Google Scholar 

  73. 73.

    Maruthur NM, Tseng E, Hutfless S, Wilson LM, Suarez-Cuervo C, Berger Z, et al. Diabetes medications as monotherapy or metformin-based combination therapy for type 2 diabetes: a systematic review and meta-analysis. Ann Intern Med. 2016;164:740–51.

    PubMed  Google Scholar 

  74. 74.

    Pfeifer S, Butts S, Dumesic D, Fossum G, Gracia C, La Barbera A, et al. Combined hormonal contraception and the risk of venous thromboembolism: a guideline. Fertil Steril. 2017;107:43–51.

    CAS  Google Scholar 

  75. 75.

    Gariani K, Hugon-Rodin J, Philippe J, Righini M, Blondon M. Association between polycystic ovary syndrome and venous thromboembolism: a systematic review and meta-analysis. Thromb Res. 2020;185:102–8.

    CAS  PubMed  Google Scholar 

  76. 76.

    Fraison E, Kostova E, Moran LJ, Bilal S, Ee CC, Venetis C, et al. Metformin versus the combined oral contraceptive pill for hirsutism, acne, and menstrual pattern in polycystic ovary syndrome. Cochrane Database Syst Rev. 2020;8(8):CD005552.

    PubMed  Google Scholar 

  77. 77.

    Samimi M, Zarezade Mehrizi M, Foroozanfard F, Akbari H, Jamilian M, Ahmadi S, et al. The effects of coenzyme Q10 supplementation on glucose metabolism and lipid profiles in women with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trial. Clin Endocrinol (Oxf). 2017;86:560–6.

    CAS  PubMed  Google Scholar 

  78. 78.

    Rezai M, Jamshidi M, Mohammadbeigi R, Seyedoshohadaei F, Mohammadipour S, Moradi G. Comparing the effect of metformin and acarbose accompanying clomiphene on the successful ovulation induction in infertile women with polycystic ovary syndrome. Glob J Health Sci. 2016;8:54516.

    PubMed  Google Scholar 

  79. 79.

    Wahab S, Farnaz Z, Karim R. Role of metformin in polycystic ovarian syndrome. J Postgrad Med Inst. 2013;27(2):179–83.

    Google Scholar 

  80. 80.

    Mohamed ANA, Mohi Eldin AM, Sallah EEM, Boraay AM. Comparative study between the effects of metformin monotherapy in obese and non-obese patients with polycystic ovary syndrome. Int J Gynecol Obstet. 2012;119:S426.

    Google Scholar 

  81. 81.

    Batra A, Saxena P, Salhan S, Mittal P, Sharma M. Role of Metformin in the treatment of polycystic ovarian disease. Int J Gynecol Obstet. 2009;107:S121.

    Google Scholar 

  82. 82.

    Hillary C, Conway A, Waung J, Elrishi M, Levy M, Howlett T. Patient reported outcomes for the use of metformin in polycystic ovarian syndrome (PCOS). Endocr Abstr. 2009;19:P296.

    Google Scholar 

  83. 83.

    Aruna J, Mittal S, Kumar S, Misra R, Dadhwal V, Vimala N. Metformin therapy in women with polycystic ovary syndrome. Int J Gynecol Obstet. 2004;87:237–41.

    CAS  Google Scholar 

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Correspondence to Yu-Chen Huang.

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All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Hsuan Yen, Yu-Tung Chang, and Fui-Yun Yee. The first draft of the manuscript was written by Hsuan Yen and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Yen, H., Chang, YT., Yee, FJ. et al. Metformin Therapy for Acne in Patients with Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis. Am J Clin Dermatol 22, 11–23 (2021). https://doi.org/10.1007/s40257-020-00565-5

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