The sebaceous gland is a target of
androgens, and hormonal influences play an important role in the multifactorial pathogenesis of
acne. In both men and women,
acne may be related to an excessive
hypersensitivity of the sebaceous end organ to
androgens. However, in women, the ovarian and adrenal production and the plasma transport of
androgens may be implicated, particularly in late-onset or persistent
acne or with associated
hirsutism. Many reports have shown that females with
acne frequently have abnormal levels of circulating
androgens. Hormonal treatment is not usually the first line in female
acne. But in relation to the possibilities, particularly the
tetracyclines, this may be a choice when one prescribes a pill like Dianette to a young woman presenting a mild
acne and who requests
contraception. However,
antiandrogen treatment is sometimes mandatory, especially in resistant
acne in adult women and/or in female
acne which is resistant or relapsing rapidly
after treatment with
Roaccutane and which is often related to
hyperandrogenism. Finally, in severe prepubertal
acne, the possible cause is an adrenal enzymatic block of which the only treatment is hormonal.