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Duration of treatment may be related to improvement as metformin improves AN and IR if given for 6 months or more [Figure 7a and b].[23] Metformin reduces glucose production by increasing peripheral insulin responsiveness, reduces hyperinsulinemia, body weight and fat mass and improves insulin sensitivity.[30,32,33] The combined use of metformin and TZDs which increase sensitivity to insulin in peripheral muscles, also give good results.[34] The combined metformin and glimepiride (at low dose) is superior in the management of IR studied through HOMA with reduction in HOMA-IR.[35] Metformin is known to improve cardiopulmonary performance in patients with high HOMA-IR possibly by favorable effects on endothelial dysfunction.[18] Cosmetic treatment Because darkening of affected areas is common in AN, Alan Rosenbach considered the possibility that long-pulsed alexandrite laser, which was designed to target melanin in hair could improve this condition

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Interesting distinction

While these medications provide promising results, they also carry potential side effects, such as gastrointestinal discomfort and a rare risk of pancreatitis