Acne refractory to isotretinoin treatment in male patients: responsibilityof androgens in 9 cases; therapeutic implications

Introduction. Treatment failures with isotretinoin in female patients are f requently related to endocrinological dysfunctions. Such a concept has neve r been discussed in male patients. Case reports. An extensive endocrinological work-up has been performed in n ine male patients who presented with an acne refractory to conventional tre atment and to isotretinoin. Adrenal dysfunction was found in four patients and isolated 5-alpha reductase hyperactivity in 2 cases. Three work-ups wer e normal. A suppressive treatment in three patients with adrenal dysfunctio n provided immediate efficacy. Comments. These results would provide insight into the mechanism of refract ory acne in men.