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Androgen excess in cystic acne
The New England Journal of Medicine
|April 28, 1983
Summary
This study found that most cystic acne cases resistant to treatment involve excess androgens. Lowering dehydroepiandrosterone sulfate (a key androgen) significantly improved or resolved acne in most women and men.
Area of Science:
- Endocrinology
- Dermatology
- Reproductive Medicine
Background:
- Cystic acne often proves resistant to standard treatments.
- Hormonal imbalances, particularly androgen excess, are implicated in severe acne.
- Understanding specific hormonal profiles in treatment-resistant acne is crucial.
Purpose of the Study:
- To investigate hormonal differences in women and men with treatment-resistant cystic acne compared to controls.
- To evaluate the efficacy of treatments aimed at reducing elevated androgen levels in these patients.
Main Methods:
- Hormone level measurements (dehydroepiandrosterone sulfate, testosterone, luteinizing hormone, 17-hydroxyprogesterone, sex-hormone-binding globulin) in 59 women and 32 men with resistant cystic acne.
- Treatment with dexamethasone and/or oral contraceptive pills (Demulen) to lower dehydroepiandrosterone sulfate.
- Assessment of acne improvement after six months of treatment.
Main Results:
- Women with acne showed higher dehydroepiandrosterone sulfate, testosterone, and luteinizing hormone, and lower sex-hormone-binding globulin.
- Men with acne exhibited higher dehydroepiandrosterone sulfate and 17-hydroxyprogesterone, and lower sex-hormone-binding globulin.
- Acne resolution or marked improvement was observed in 97% of women and 81% of men after treatment.
Conclusions:
- Therapeutically resistant cystic acne is frequently associated with androgen excess.
- Reducing elevated dehydroepiandrosterone sulfate levels leads to significant acne improvement or remission.
- Low-dose dexamethasone is effective in managing androgen excess in acne patients.