Serum
androsterone glucuronide (AoG) is a metabolite of circulating
androgens under the influence of 5alpha-reductase activity and has been shown to be particularly elevated in women with
acne. In this study, we wanted to evaluate changes in AoG before and
after treatment with an
oral contraceptive or placebo, and to assess whether changes correlated with the number and type of
acne lesions. In order to accomplish these aims, we obtained sera from a completed prospective randomized trial, which was designed to assess the effectiveness of an
oral contraceptive compared to placebo. Assessments were carried out in 56 women with moderate
acne who were treated with
Ortho Tri-Cyclen (
norgestimate and ethinylestradiol) (30 patients) or placebo (26 patients) for 6 months. Before and
after treatment, the number and type of skin lesions, serum levels of total T, free-T, DHEAS and AoG were determined. Serum AoG increased significantly in women with moderate
acne, although T, free-T and DHEAS were normal. 75% of
acne patients had elevated levels of serum AoG. Ratios of serum AoG to
androgen precursors were also elevated.
Oral contraceptive (OC) treatment significantly reduced levels of free-T and AoG, both of which were unaffected by placebo. While both OC and placebo treatment resulted in improvement of comedones and inflammatory lesions, OC treatment decreased inflammatory lesions to a greater extent (p<0.05).
After treatment, serum AoG correlated with the number of inflammatory lesions. Results showed that serum AoG is a sensitive marker of
acne in women, even in those with normal circulating precursor
androgens; and is lowered by OC treatment, correlating with the reduction of inflammatory lesions. We hypothesize that the increase of serum AoG in normoandrogenic
acne may be related to
inflammation, and serum AoG may serve as a marker of this process.