ACNE-VULGARIS IN PREMENARCHAL GIRLS - AN EARLY SIGN OF PUBERTY ASSOCIATED WITH RISING LEVELS OF DEHYDROEPIANDROSTERONE

Background: This study examined the relationships of pubertal maturati on and sex steroid hormones Lo the development of acne in young girls. Black (n=317) and white (n=306) premenarchal girls with a mean age of 9.97+/-0.62 years were evaluated for acne prevalence and severity, pu bic hair and areolar maturation, and sex steroid hormone levels. Resul ts: Overall, 77.8% of the girls had some acne; of the whole group, 48. 3% had only comedonal acne, 2.2% had only inflammatory acne, and 27.3% had both types. Although black girls matured at an earlier age than w hite girls, racial differences in acne were minimal when adjusted for pubertal maturation. Acne increased with advancing maturation; at Tann er pubic hair stages 1, 2, and 3, the prevalence of acne rose from 73. 1% to 84.0% and to 90.6%, respectively. Acne lesion counts at seven fa cial locations revealed a predominance of midfacial acne on the middle aspect of the forehead, nose, and chin. Sex steroid hormone levels me asured in 365 of the girls were found to increase significantly during maturation from prepuberty Lo early puberty. Testosterone-estrogen-bi nding globulin and the ratio of testosterone to estradiol decreased. I n 118 prepubertal girls, estradiol, total and free testosterone, proge sterone, testosterone to estradiol ratio, and testosterone-estrogen-bi nding globulin levels were no different whether in subjects with acne or without acne. However, the level of dehydroepiandrosterone sulfate, an androgen of adrenal origin, was significantly higher in prepuberta l girls with acne. Conclusion: Acne, especially the comedonal type, ca n be the first sign of pubertal maturation in girls, even preceding pu bic hair and areolar development. Concentration of dehydroepiandroster one sulfate is significantly and specifically associated with the init iation of acne in young girls.