Androgen excess in cystic acne.
We measured hormone levels in 59 women and 32 men with longstanding cystic acne resistant to conventional therapy. Affected women had higher serum levels of dehydroepiandrosterone sulfate, testosterone, and luteinizing hormone and lower levels of sex-hormone-binding globulin than controls. Affected men had higher levels of serum dehydroepiandrosterone sulfate and 17-hydroxyprogesterone and lower levels of sex-hormone-binding globulin than controls. To lower dehydroepiandrosterone sulfate, dexamethasone was given to men, and dexamethasone or an oral contraceptive pill, Demulen (or both), was given to women. Of the patients treated for six months, 97 per cent of the women and 81 per cent of the men had resolution or marked improvement in their acne. The dose of dexamethasone required to reduce dehydroepiandrosterone sulfate levels was low, rarely exceeding the equivalent of 20 mg of hydrocortisone per day. We conclude that most patients with therapeutically resistant cystic acne have androgen excess and that lowering elevated dehydroepiandrosterone sulfate results in improvement or remission of acne in most instances.
D019326:17-alpha-Hydroxyprogesterone; D000152:Acne Vulgaris / Q000097:blood* / Q000188:drug therapy; D000328:Adult; D000728:Androgens / Q000097:blood*; D000735:Androstenedione / Q000097:blood; D003277:Contraceptives, Oral, Combined / Q000627:therapeutic use; D003560:Cysts / Q000097:blood / Q000188:drug therapy; D003687:Dehydroepiandrosterone / Q000097:blood; D003907:Dexamethasone / Q000627:therapeutic use; D004338:Drug Combinations; D004997:Ethinyl Estradiol / Q000627:therapeutic use; D005040:Ethynodiol Diacetate / Q000627:therapeutic use; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006908:Hydroxyprogesterones / Q000097:blood; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D012738:Sex Hormone-Binding Globulin / Q000032:analysis; D012871:Skin Diseases / Q000097:blood / Q000188:drug therapy; D013739:Testosterone / Q000097:blood
D000728:Androgens; D003277:Contraceptives, Oral, Combined; D004338:Drug Combinations; D006908:Hydroxyprogesterones; D012738:Sex Hormone-Binding Globulin; D013739:Testosterone; D000735:Androstenedione; D004997:Ethinyl Estradiol; D003687:Dehydroepiandrosterone; D005040:Ethynodiol Diacetate; D019326:17-alpha-Hydroxyprogesterone; D003907:Dexamethasone; C021601:SC-11800 EE; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; D006854:Hydrocortisone