Is acne a sign of androgen excess disorder or not?
OBJECTIVE
Acne is not solely a cosmetic problem. The clinical importance of acne in the estimation of androgen excess disorders is controversial. Recently, the Amsterdam ESHRE/ASRM-sponsored third PCOS Consensus Workshop Group suggested that acne is not commonly associated with hyperandrogenemia and therefore should not be regarded as evidence of hyperandrogenemia. Our aim was to investigate whether acne is a sign of androgen excess disorder or not.


METHODS
This is a cross sectional study that was performed in a university hospital involving 207 women, aged between 18 and 45 years, suffering mainly from acne. The women were assigned as polycystic ovary syndrome (PCOS), idiopathic hirsutism (IH), idiopathic hyperandrogenemia (IHA). Women with acne associated with any of the androgen excess disorders mentioned above were named as hyperandrogenemia associated acne (HAA). Women with acne but without hirsutism and hyperandrogenemia and having ovulatory cycles were named as "isolated acne". Serum luteinizing hormone, follicle stimulating hormone, estradiol, progesterone, 17-hydroxyprogesterone, dehydroepiandrosterone-sulfate (DHEAS), androstenedione, total testosterone and lipid levels were measured.


RESULTS
Acne score was similar between the women with isolated acne and HAA. The most common cause for acne was PCOS and only 28% of the women had isolated acne. 114 (55%) women had at least one raised serum androgen level.


CONCLUSIONS
In this study, 72% of acneic women had clinical and/or biochemical hyperandrogenemia. In contrast to the suggestion of ESHRE/ASRM-sponsored third PCOS Consensus Workshop Group, our data indicate that the presence of androgen excess disorders should be evaluated in women presenting with acne.
Department of Obstetrics and Gynecology, Adana Numune Education and Research Hospital, Adana, Turkey. Electronic address: gulsumaykut@yahoo.com.
Gulsum
G
Uysal
Department of Obstetrics and Gynecology, Erciyes University Medical School, Kayseri, Turkey.
Yılmaz
Y
Sahin
Department of Endocrinology, Erciyes University Medical School, Kayseri, Turkey.
Kursad
K
Unluhizarci
Department of Dermatology, Erciyes University Medical School, Kayseri, Turkey.
Ayten
A
Ferahbas
Department of Obstetrics and Gynecology, Erciyes University Medical School, Kayseri, Turkey.
Semih Zeki
SZ
Uludag
Department of Obstetrics and Gynecology, Erciyes University Medical School, Kayseri, Turkey.
Ercan
E
Aygen
Department of Endocrinology, Erciyes University Medical School, Kayseri, Turkey.
Fahrettin
F
Kelestimur
D000152:Acne Vulgaris / Q000097:blood / Q000209:etiology*; D000293:Adolescent; D000328:Adult; D000735:Androstenedione / Q000097:blood; D003430:Cross-Sectional Studies; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D004958:Estradiol / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006628:Hirsutism / Q000097:blood / Q000150:complications*; D006801:Humans; D017588:Hyperandrogenism / Q000097:blood / Q000150:complications*; D007986:Luteinizing Hormone / Q000097:blood; D008875:Middle Aged; D011085:Polycystic Ovary Syndrome / Q000097:blood / Q000150:complications*; D011374:Progesterone / Q000097:blood; D012738:Sex Hormone-Binding Globulin; D013739:Testosterone / Q000097:blood; D055815:Young Adult
D012738:Sex Hormone-Binding Globulin; D013739:Testosterone; D000735:Androstenedione; D011374:Progesterone; D004958:Estradiol; D019314:Dehydroepiandrosterone Sulfate; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone
Acne; Androgen excess disorders; Hirsutism; Hyperandrogenemia; Polycystic ovary syndrome