Androgen Excess in Cystic Acne

• Published in: The New England journal of medicine Vol. 308; no. 17; pp. 981 - 986
• Main Authors: Marynick, Samuel P, Chakmakjian, Zaven H, McCaffree, David L, Herndon, James H
• Format: Journal Article
• Language: English
• Published: United States Massachusetts Medical Society 28.04.1983
• Subjects: 17-alpha-Hydroxyprogesterone; Acne Vulgaris - blood; Acne Vulgaris - drug therapy; Adult; Androgens - blood; Androstenedione - blood; Contraceptives, Oral, Combined - therapeutic use; Cysts - blood; Cysts - drug therapy; Dehydroepiandrosterone - blood; Dexamethasone - therapeutic use; Ethinyl Estradiol - therapeutic use; Ethynodiol Diacetate - therapeutic use; Female; Follicle Stimulating Hormone - blood; Humans; Hydrocortisone - blood; Hydroxyprogesterones - blood; Luteinizing Hormone - blood; Male; Sex Hormone-Binding Globulin - analysis; Skin Diseases - blood; Skin Diseases - drug therapy; Testosterone - blood
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJM198304283081701

We measured hormone levels in 59 women and 32 men with long-standing cystic acne resistant to conventional therapy. Affected women had higher serum levels of dehydroepiandrosterone sulfate, testosterone, and luteinizing hormone and lower levels of sex-hormone-binding globulin than controls. Affected men had higher levels of serum dehydroepiandrosterone sulfate and 17-hydroxyprogesterone and lower levels of sex-hormone-binding globulin than controls. To lower dehydroepiandrosterone sulfate, dexamethasone was given to men, and dexamethasone or an oral contraceptive pill, Demulen (or both), was given to women. Of the patients treated for six months, 97 per cent of the women and 81 per cent of the men had resolution or marked improvement in their acne. The dose of dexamethasone required to reduce dehydroepiandrosterone sulfate levels was low, rarely exceeding the equivalent of 20 mg of hydrocortisone per day. We conclude that most patients with therapeutically resistant cystic acne have androgen excess and that lowering elevated dehydroepiandrosterone sulfate results in improvement or remission of acne in most instances. (N Engl J Med 1983;308:981–6.) Therapeutically resistant cystic acne is defined as cystic acne of more than one year's duration that is uncontrolled by standard dermatologic therapy, and usually leads to the development of deforming scar tissue. We have systematically evaluated the endocrinologic function of women and men with this disorder. In this paper we report evidence that patients with therapeutically resistant cystic acne commonly have androgen excess, and we evaluate the clinical effect of drug therapy designed to lower serum androgen levels. Methods We studied 132 women and 54 men with severe cystic acne. Each patient was originally seen by us or was referred . . .