RAISED SERUM 11-DEOXYCORTISOL IN MEN WITH PERSISTENT ACNE-VULGARIS

OBJECTIVE Acne vulgaris is androgen dependent but the hormonal mechani sms are unclear, Although there have been many studies of serum hormon es in women with acne there are few studies in men and the results are conflicting, We have therefore carried out a further study in men. DE SIGN AND PATIENTS Fifty men with acne vulgaris were age-matched agains t 50 normal men. MEASUREMENTS Serum levels of dehydroepiandrosterone s ulphate (DHEAS), 17 alpha-hydroxyprogesterone, 11-deoxycortisol, andro stenedione and testosterone were measured by radioimmunoassay, sex hor mone binding globulin (SHBG) by immunoradiometric assay and LH, FSH an d oestradiol by automated ELISA. RESULTS The acne patients had higher levels of androstenedione, median 7.35 nmol/l, (interquartile range 2. 7) vs 6.05 (2.3), P=0.004; testosterone, 21.7 nmol/l (7.5) vs 17.55 (7 .7), P=0.04; and free androgen index (FAI) 78.26 (40) vs 65.06 (20), P =0.007, but also had higher levels of 11-deoxycortisol, 13.65 nmol/l ( 4.3) vs 12.0 (4.3), P=0.022, The LH, FSH, 17 alpha-hydroxyprogesterone , DHEAS, oestradiol and SHBG levels were not significantly different, Examination of the Spearman rank correlation coefficient matrices for the serum gesterone, androstenedione showed that the strongest correla tion was between androstenedione and 11-deoxycortisol. CONCLUSION Alth ough there was overlap between the results of the acne patients and co ntrols the acne patients tended to have higher levels of androstenedio ne, testosterone, free androgen index and 11-deoxycortisol, The higher levels of 11-deoxycortisol are suggestive of 11 beta-hydroxlase dysfu nction which could be due to a primary adrenal defect or a consequence of raised androgens, Also, a pathway between androstenedione and 11-d eoxycortisol has been described in sheep and, although unsubstantiated in man, requires consideration.