The role of androgens in determining acne severity in adult women

Background Although many arguments have been put forth supporting the role of androgens in the aetiology of acne, their part in determining the severi ty of the disease is not well established. Objectives The aim of our study was to evaluate the relationship between ac ne severity and the clinical and laboratory markers of androgenicity in a l arge group of patients. Methods Ninety women over 17 years of age with acne were enrolled into the study. The levels of testosterone, androstenedione, dehydroepiandrosterone, dehydroepiandrosterone sulphate and sex hormone binding globulin (SHBG) we re measured. Menstrual cycle regularity, hirsutism score, acne severity and ultrasound evaluation of polycystic ovaries were recorded. One-way analysi s of variance, chi(2)-test and correlation analysis were used for data proc essing. Results Hirsutism was documented in 19 (21%) subjects, elevated levels of a t least one androgen in 73 (81%) subjects, an irregular cycle was reported by 43 (48%) women, and polycystic ovaries were found in 45 (50%) women. The patients were divided into three groups according to acne severity, Acne w as graded using the Leeds technique as minor in 43 (48%) cases, mild in 27 (30%) and moderate in 20 (22%), We did not demonstrate a positive correlati on between the grade of acne severity and any of the clinical or laboratory markers of androgenicity assessed. On the contrary, women with a higher gr ade of acne severity showed lower values of the index of free testosterone, a lower hirsutism score and higher SHBG levels. Conclusions Our study suggests that the severity of acne manifestation in a dult women is not determined by androgen production.