Hormonal treatment of acne

Las Vegas

- When an adult female presents with acne, it can be very helpful to do a hormonal evaluation, including a menstrual history, use of cosmetic and skincare products and clinical signs of cutaneous androgen excess, says Diana S. Berson, M.D., in a presentation here at the Fall Clinical Dermatology Conference.

When assessing endocrine function in women, it’s important to remember that most adult females with acne have normal serum levels of androgens, and don’t have a hormonal problerm, Dr. Berson says. ":Most of what we all refer to as ‘hormonal acne’ is actually just related to an increased local activity of androgens at the sebaceous gland level, and usually there is no need for routine hormonal work-up."

You do want to consider an evaluation for endocrinopathies, however, if the patient has irregular menstrual cycles, hirisutism or alopecia, a sudden onset of severe inflammatory acne or therapy resistant acne, Dr. Berson says. "Usually, our firstline evaluation is to look for an adrenal, ovarian or pituitary abnormality."

If there is a hormonal abnormality we target either the adrenal gland or the ovary we give the appropriate therapies. But for women with normal androgens, which are most the women you are going to see on an everyday basis, you still can take advantage of hormonal therapy."

Hormonal therapies include glucocorticosteroids for patients with adrenal hyperplasia, oral contraceptives, which is the firstline agent for hormonal acne in women who are otherwise healthy, and steroidal antiandrogens, such as spironolactone, says Dr. Berson. " The one thing that all these treatments have in common is they decrease sebum production, she says."DT