Acne is a multifactorial disorder reflecting the role of
infection, abnormal keratinization and immunologic reaction, as well as hormonal influences, on the pilosebaceous unit. Clinical studies have correlated elevated levels of
androgens, originating in both the adrenal glands and ovaries, with
acne. These include total and free
testosterone, delta 4-androstenedione,
dehydroepiandrosterone and its
sulfate, and low levels of
sex hormone binding globulin. The pathogenesis of
acne initiation in childhood has been linked to rising serum levels of
dehydroepiandrosterone sulfate.
Hirsutism has been more directly correlated with increased levels of serum
androgens, notably free
testosterone. Underlying causes of elevated
androgens in both disorders include very rare
tumors, partial or late-onset forms of
congenital adrenal hyperplasia, developmental adrenal abnormalities and, most commonly,
polycystic ovary syndrome. Early
acne treatment may include topical
benzoyl peroxide,
antibiotics, and
tretinoin. More severe disease can be treated systemically (with
antibiotics and/or
isotretinoin). Very-low-dose
corticosteroids can be used to eliminate the adrenal component of
hyperandrogenism.
Oral contraceptives, especially those that contain low-androgenic
progestins, can reduce excessive
androgens from any source and specifically suppress the ovary in
polycystic ovary syndrome.
Gonadotropin-releasing hormone agonists, with or without
estrogen supplementation, and systemic or topical
antiandrogens may play a more important role in the future.