HORMONAL CORRELATES OF ACNE AND HIRSUTISM

Acne is a multifactorial disorder reflecting the role of infection, ab normal keratinization and immunologic reaction, as well as hormonal in fluences, on the pilosebaceous unit. Clinical studies have correlated elevated levels of androgens, originating in both the adrenal glands a nd ovaries, with acne. These include total and free testosterone, Delt a(4)-androstenedione, dehydroepiandrosterone and it's sulfate, and low levels of sex hormone binding globulin. The pathogenesis of acne init iation in childhood has been linked to rising serum levels of dehydroe piandrosterone sulfate. Hirsutism has been more directly correlated wi th increased levels of serum androgens, notably free testosterone. Und erlying causes of elevated androgens in both disorders include very ra re tumors, partial or late-onset forms of congenital adrenal hyperplas ia, developmental adrenal abnormalities and, most commonly, polycystic ovary syndrome. Early acne treatment may include topical benzoyl pero xide, antibiotics, and tretinoin. More severe disease can be treated s ystemically (with antibiotics and/or isotretinoin). Very-low-dose cort icosteroids can be used to eliminate the adrenal component of hyperand rogenism. Oral contraceptives, especially those that contain low-andro genic progestins, can reduce excessive androgens from any source and s pecifically suppress the ovary in polycystic ovary syndrome. Gonadotro pin-releasing hormone agonists, with or without estrogen supplementati on, and systemic or topical antiandrogens may play a more important ro le in the future.