Sebaceous gland suppression in female acne patients by combined glucocorticoid-oestrogen therapy

Women with severe acne were treated with a combination of oestrogen and a low dose of glucocorticoid daily in order to suppress their androgen production. This combination therapy reduced their sebum production by 50%, with a concomitant improvement in their acne.     

Anti-androgen treatment in women with acne: a controlled trial

Ninety female patients with acne were allocated randomly to one of three groups and treated either with Diane, a high dose cyproterone acetate (CPA) regime with ethinyloestradiol, or Minovlar. The same dose of oestrogen was common to all three treatment groups. Patients were assessed every 2 months for 6 months, by grading for severity of the acne, lesion counts and photography, and subjectively using a visual analogue scale. In addition, bacteriological sampling and sebum excretion rate (SER) measurements were performed. The results showed a clinical improvement in all three treatment groups, but a more rapid and complete response was seen in those groups who received CPA. There was also a consistent trend suggesting a more favourable response in those in the high dose CPA group. Although there was a marked reduction in SER in the groups treated with CPA, there was no correlation between reduction in SER and clinical improvement in individuals, nor could a reduction in the surface bacterial population be shown to be a primary event in the success of anti-androgen therapy. We have shown that the addition of CPA to oestrogen adds significantly to the therapeutic effect in acne and that anti-androgen and oestrogen combinations are more effective than standard oestrogen and progestagen contraceptive pills.     

伴多囊卵巢综合征的痤疮性激素水平变化及相关分析

为探讨成年女性痤疮患者血清性激素水平的变化及与多囊卵巢综合征（PCOS）的相关性，对60例成年女性痤疮患者进行血清性激素水平测定和妇科B超检查，其中24例伴PCOS痤疮患者行腹腔镜下微波治疗。结果发现患者组血清睾酮（T），黄体生成素（LH）高于对照组（P＜0．05），微波术后其T，LH值明显下降（P＜0．05），该手术对痤疮治愈率和总有效率分别为58．3％和91．7％，提示成年女性痊痤疮与PCOS有相关性，高雄激素血症可能是引起女性痤疮的主要因素之一。     

Circulating testosterone, sex hormone binding globulin and prolactin in women with late onset or persistent acne vulgaris

Serum testosterone, sex hormone binding globulin (SHBG) and prolactin were measured in thirty-eight women with acne which persisted or started after the age of 18 years. One or more of these levels were abnormal in 76% of patients. Increased testosterone or low SHBG were present alone or in combination in 60% of patients. This group was presumed to have a raised level of non-protein bound, metabolically-available testosterone. Hyperprolactinaemia, which was present in 45% of patients, may be important in view of the reported association with increased adrenal androgens. The hormonal abnormalities may be causally related to the acne and a greater understanding of them may lead to better treatment.     

Low-dose adjunctive spironolactone in the treatment of acne in women: a retrospective analysis of 85 consecutively treated patients

BACKGROUND: Despite advances in acne therapy in recent years, treatment failures are common, especially in adult women. Spironolactone, an established androgen receptor blocker, is successful in treating adult women with acne, but side effects are common at the doses reported in published studies to date. OBJECTIVE: The purpose of this study was to assess the therapeutic effect and tolerance of low doses of spironolactone used alone or as an adjunct in the treatment of acne in adult women. METHODS: Records were reviewed from 85 women with acne treated consecutively with spironolactone 50 to 100 mg/day, administered either as single-drug therapy or as an adjunct to standard therapies. The maximum length of treatment was 24 months. RESULTS: Clearing of acne occurred in 33% of patients treated with low doses of spironolactone; 33% had marked improvement, 27.4% showed partial improvement, and 7% showed no improvement. The treatment regimen was well tolerated, with 57.5% reporting no adverse effects. CONCLUSION: Spironolactone can be used in low doses as a single drug or as an adjunct to standard acne therapies in women with adult acne. When used in this fashion, treatment outcomes are favorable, and the drug is well tolerated.     

Pituitary function and DHEA-S in male acne and DHEA-S, prolactin and cortisol before and after oral contraceptive treatment in female acne

Pituitary function (TRH-LHRH stimulation test) was investigated in male acne patients and serum levels of dehydroepiandrosterone sulphate (DHEA-S), sex hormone binding globulin (SHBG) and other biochemical parameters were investigated in male acne patients and in female acne patients before and after treatment with an oral contraceptive. The TRH-LHRH stimulation test was performed with 15 male patients suffering from severe cystic acne and 7 healthy volunteers. Basal and stimulated prolactin, LH and FSH levels were statistically similar in the patients and control groups. However, the stimulated LH levels of the patients were 60% higher than those in controls. SHBG levels were significantly) higher in the patient group compared to those in the control group. Thirty-three female acne patients were randomly divided into two groups and treated for six months with an oral contraceptive containing 0.030 mg ethinylestradiol (EE) plus 0.150 mg levonorgestrel or 0.150 mg levonorgestrel. After six months' treatment a 30% decrease in DHEA-S levels were observed in the desogestrel/EE group and a 15% decrease in the levonorgestrel/EE group; the difference was not statistically significant. At the same time serum total cortisol increased by 75-100% and free testosterone fell by 30-40% in both groups, whereas SHBG elevated 250% in the desogestrel/EE group and 30% in the levonorgestrel/EE group. Acne improved significantly in both groups, desogestrel/EE showing greater improvement. A decrease in SHBG and increase in DHEA-S levels appear to be the most common hormonal changes in acne. Oral contraceptive treatment induces an increase in SHBG and decrease in DHEA-S and also improves acne.     

The effectiveness of intermittent isotretinoin treatment in mild or moderate acne

BACKGROUND: Isotretinoin is the only drug that affects almost all factors in acne pathogenesis. Recently, its use for the treatment of chronic mild or moderate acne unresponsive to long-term antibiotic therapy, and with a tendency to cause scarring and leading to negative psychological effects, has became popular. The aim of the study was to investigate the effectiveness of intermittent isotretinoin treatment in mild or moderate acne. METHODS: Sixty patients with mild or moderate acne localized to the face were enrolled in the study. The treatment regimen consisted of isotretinoin, 0.5-0.75 mg/kg per day, applied for 1 week every 4 weeks for a total period of 6 months, according to the degree of acne and number of inflammatory lesions. RESULTS: Forty-one (68.3%) of the 60 patients completed the 6-month therapy. At the end of the treatment complete improvement was observed in 34 patients (82.9%) out of 41. All adverse effects were mild and discontinuation of the treatment was not necessary. CONCLUSION: Intermittent isotretinoin treatment was found to be a safe and effective choice for patients with mild or moderate acne.     

A comparison of the effectiveness of topical tetracycline, benzoyl-peroxide gel and oral oxytetracycline in the treatment of acne

A proprietary topical tetracycline preparation (Topicycline) was compared with an alcohol-based 5% benzoyl-peroxide gel and with oral oxytetracycline (250 mg twice daily) using a randomized group-comparative double-blind study in 69 patients with mild to moderate acne. Facial acne grades improved significantly in all three treatment groups over the 12-week study period but chest acne grades did not change significantly and only oxytetracycline produced a significant improvement in back grade. All three treatment groups produced a significant reduction in facial inflamed and non-inflamed lesions apart from oxytetracycline which failed to produce a significant reduction in inflamed lesions. However, there were no overall significant differences between the three treatment groups either in improvement of acne grade or in reduction of inflamed and non-inflamed lesions. We conclude that topical tetracycline is as effective as either 5% benzoyl-peroxide gel or 250 mg oxytetracycline twice daily in the treatment of mild to moderate acne.     

Serum total and unbound testosterone and sex hormone binding globulin (SHBG) in female acne patients treated with two different oral contraceptives

Serum total an unbound testosterone (T) and sex hormone binding globulin (SHBG) levels were studied in fifty-four female acne patients before treatment and during the treatment by two different oral contraceptives, the other containing 0.150 mg desogestrel plus 0.03 mg EE and the other 0.150 mg levonorgestrel plus 0.03 mg EE. Pretreatment values were abnormal in 57% of the patients. A borderline significant correlation between the severity of acne and SHBG was found. Ater six months' treatment a 250% increase in SHBG was seen in desogestrel/EE group and no significant change in SHBG in levonorgestrel/EE group. However, at the same time serum free testosterone fell 60% in both treatment groups. SHBG cannot be the only regulator of serum free testosterone. Acne improved significantly in both treatment groups. It is likely that the improvement was in connection with the free testosterone decrease and the improvement was better in the desogestrel/EE group where also SHBG elevation was seen.     

Therapie der Akne mit Antiandrogenen – Eine evidenzbasierte Übersicht

Background: Increased sebaceous gland activity with seborrhea is one of the major pathogenetic factors in acne. Antiandrogen treatment targets the androgen‐metabolizing follicular keratinocytes and the sebaceous gland leading to sebostasis, with a reduction of the sebum secretion rate of 12.5 – 65 %. Antiandrogens can be classified based on their mechanism of action as androgen receptor blockers, inhibitors of circulating androgens by affecting ovarian function (oral contraceptives), inhibitors of circulating androgens by affecting the pituitary (gonadotropin‐releasing hormone agonists and dopamine agonists in hyperprolactinemia), inhibitors of adrenal function, and inhibitors of peripheral androgen metabolism (5α‐reductase inhibitors, inhibitors of other enzymes). Methods: All original and review publications on antiandrogen treatment of acne as monotherapy or in combination included in the MedLine system were extracted by using the terms “acne”, “seborrhea”, “polycystic ovary syndrome”, “hyperandrog*”, and “treatment” and classified according to their level of evidence. Results: The combinations of cyproterone acetate (2 mg)/ethinyl estradiol (35 µg), drospirenone (3 mg)/ethinyl estradiol (30 µg), and desogestrel (25 µg)/ethinyl estradiol (40 µg) for 1 week followed by desogestrel (125 µg)/ethinyl estradiol (30 µg) for 2 weeks showed the strongest anti‐acne activity. Gestagens or estrogens as monotherapy, spironolactone, flutamide, gonadotropin‐releasing hormone agonists, and inhibitors of peripheral androgen metabolism cannot be endorsed based on current knowledge. Low dose prednisolone is only effective in late‐onset congenital adrenal hyperplasia and dopamine agonists only in hyperprolactinemia. Treatment with antiandrogens should only be considered if none of the contraindications exist. Conclusion: Antiandrogen treatment should be limited to female patients with additional signs of peripheral hyperandrogenism or hyperandrogenemia. In addition, women with late‐onset or recalcitrant acne who also desire contraception can be treated with antiandrogens as can those being treated with systemic isotretinoin. Antiandrogen treatment is not appropriate primary monotherapy for noninflammatory and mild inflammatory acne.     

Analysis of clinical efficacy,side effects,and laboratory changes among patients with acne vulgaris receiving single versus twice daily dose of oral isotretinoin

Acne vulgaris is a debilitating disorder and requires proper treatment. This work evaluates the clinical efficacy, side effects, and laboratory changes of serum lipids and liver function during oral isotretinoin therapy for acne vulgaris, comparing single versus twice daily dose. Fifty‐eight patients with acne vulgaris were included and randomized into group I (26 patients), who received once daily dose, and group II (32 patients), who received twice daily dose of oral isotretinoin. Global acne scoring system was used to evaluate acne severity and post‐treatment improvement. Both regimens resulted in highly significant clinical improvement of acne with no significant difference. However, side effects were significantly more common among patients of group I. Both regimens caused mild rise of serum cholesterol, alanine transaminase (ALT), and aspartate aminotransferase (AST) with more prominent rise of triglycerides especially with twice daily dose. Oral isotretinoin is a very effective treatment for acne vulgaris with no statistically significant difference in clinical efficacy between once and twice daily doses. However, dividing dose to twice per day might cause fewer incidence of side effects without reducing clinical efficacy. The drug causes mild clinically insignificant rise of serum cholesterol, triglycerides, AST, and ALT.     

Effect of insulin‐like growth factor‐1 deficiency or administration on the occurrence of acne

Background The role of growth hormone, insulin, and insulin‐like growth factor‐1 (IGF‐1) in the development of acne is incompletely understood. Objective To study the effect of the absence of IGF‐1 and its pharmacologic replacement on the occurrence of acne vulgaris. Patients and Methods Laron syndrome (LS) is characterized by congenital IGF‐1 deficiency. The study group consisted of 21 patients with classical LS, who underwent puberty: 13 (8 male, 5 female) untreated and under regular follow‐up until age 20?48 years; and 8 (2 male, 6 female) treated with IGF‐1 (70–200 μg/kg/day), including 6 adults (2 male, treated at age 14.5–29 years and 4 female, treated at age 30–37 years) and 2 adolescents (2 female, treated at age 3.5–16 years). The medical files were reviewed for occurrence of acne and the corresponding sex hormone levels, and the findings were compared between the treated and untreated patients. Results Puberty was delayed in all untreated patients. Only one patient had slight acne at age 22 years, when he reached full puberty. Among the 2 IGF‐1 treated male patients, none acquired acne. Among the 6 treated female patients, 3 had signs of hyperandrogenism (oligo‐amenorrhea) and acne during IGF‐1 over‐dosage. On reduction of the IGF‐1 dose (to 50 μg/kg/day) or cessation of treatment, the acne disappeared in all 3 patients. Conclusion This study demonstrates for the first time that serum IGF‐1 deficiency prevents the occurrence of acne. The findings suggest that an interaction between IGF‐1 and androgens is necessary for the development of acne.     

Effectiveness of conventional, low-dose and intermittent oral isotretinoin in the treatment of acne: a randomized, controlled comparative study

Background The efficacy of conventional isotretinoin treatment (0·5–1·0 mg kg^?1 daily for 16–32 weeks, reaching a cumulative dose of 120 mg kg^?1) for acne has been well established. To date, there are many reports regarding the efficacy of low‐dose and intermittent isotretinoin treatment in patients with acne. Data comparing these three therapeutic regimens simultaneously, however, are unavailable. Objectives To evaluate the clinical efficacy and tolerability of low‐dose and intermittent isotretinoin regimens and to compare them directly with conventional isotretinoin treatment. Methods In this study, 60 patients with moderate acne were enrolled and randomized to receive either isotretinoin at 0·5–0·7 mg kg^?1 daily (group A), isotretinoin at 0·25–0·4 mg kg^?1 daily (group B) or isotretinoin at 0·5–0·7 mg kg^?1 daily for 1 week out of every 4 weeks (group C). The total period of drug administration was 6 weeks in group C, and 24 weeks in groups A and B. Evaluations included global acne grading system (GAGS) scores, lesion counts (inflammatory and noninflammatory), patient satisfaction and side‐effects. A 1‐year follow‐up evaluation after the end of treatment was also performed. Results Differences in GAGS scores were statistically significant between groups A and C (P < 0·001) and groups B and C (P = 0·044). There was no significant difference between groups A and B. For the number of inflammatory lesions, there were statistically significant differences between groups B and C (P = 0·048) and groups C and A (P = 0·005). There was no significant difference between groups A and B. For the number of noninflammatory lesions, there were statistically significant differences between groups B and C (P = 0·046) and groups C and A (P = 0·006). There was no significant difference between groups A and B. These results suggest that the conventional and low‐dose regimens have similar efficacy. Intermittent treatment had less effect than either conventional or low‐dose treatments. Patient satisfaction was highest in group B (3·76), followed by group C (3·31), then A (3·06), with statistically significant differences between groups A and B (P = 0·003) and groups B and C (P = 0·019) but no significant difference between groups A and C. This result suggests that the low‐dose regimen is superior to other regimens (conventional or intermittent) in terms of patient satisfaction. Side‐effects were more frequent with conventional treatment compared with low‐dose and intermittent treatments. One year after the end of treatment, two of 16 patients relapsed in group A, three of 17 patients relapsed in group B, and nine of 16 patients relapsed in group C. Conclusions Our study suggests that, when considering tolerability, efficacy and patient satisfaction, low‐dose treatment is most suitable for patients with moderate acne.     

Long-term treatment of severe nodulo-cystic acne with 13-cis retinoic acid

15 patients with severe nodulo-cystic acne were treated with 13-cis retinoic acid (Ro 4-3780) for 6 to 12 months. The initial dose was 40 mg/day in all the cases. In 14 out of 15 cases this dose was progressively reduced depending on improvement of the acne lesions and on the occurrence of side effects. In one case the initial dose was later increased to 60 mg/day because of lack of response to the treatment. A 75 p. 100 improvement in the severity of the acne lesions was achieved within 4 to 5 months. Complete disappearance of the lesions was achieved in most of the patients after between 6 and 12 months of treatment. The most frequent clinical side effects were dryness of the lips, cheilitis with rhagades and facial dermatitis. Abnormal increased values of hepatic enzymes and triglycerides were found in some patients.     

Incidence of polycystic ovaries in patients with late-onset or persistent acne: hormonal reports

Forty-six women affected by late-onset or persistent acne were studied in order to investigate the frequency of hormonal abnormalities and polycystic ovaries. Hirsutism, perioral distribution of acne lesions and irregular menses were recorded. Hormonal measurements and ovarian echographies were performed. Twenty-four patients were affected with polycystic ovaries, detected by ultrasound scanning. Among the acne patients, the women with ovarian abnormalities had higher values of androstenedione, dehydroepiandrosterone, dehydroepiandrosterone sulfate and luteinizing hormone (LH), and a higher LHT/follicle-stimulating hormone ratio than those with acne and without ovarian abnormalities. This study indicates the prevalence of polycystic ovaries in women with late-onset or persistent acne. Moreover, hormonal abnormalities indicate a subgroup of acne patients defined by the presence of ovarian disorders.     

Androgen status in women with late onset or persistent acne vulgaris

The androgen status of fifty women with persistent or late onset acne vulgaris has been investigated. Abnormalities of serum androgens and sex hormone binding globulin (SHBG) alone or in combination were present in 52% of the patients. Elevated serum testosterone and low SHBG were the commonest abnormalities found (46%). Raised levels of serum dehydroepiandrosterone (DHA) and DHA sulphate were present in 16% and 12% of patients respectively, but elevation of one or other of these androgens was the sole abnormality in only 6% of patients. Serum prolactin was raised in 18% of patients but there was no correlation between prolactin and androgen levels. There was also no correlation between the androgen levels and the severity, distribution or pattern of acne or the presence of hirsuties or irregular periods. The hormonal abnormalities found in this group of patients with acne are similar to those seen in females with the polycystic ovary syndrome and idiopathic hirsuties.     

雌激素联合克罗米芬治疗多囊卵巢综合征效果研究

目的:探讨雌激素联合克罗米芬治疗多囊卵巢综合征患者的效果及对患者性生活状况的影响。方法:选择2015年7月至2016年7月在本院治疗的多囊卵巢综合征患者98例,随机分为观察组和对照组,各49例,对照组患者采用克罗米芬治疗,观察组在对照组的基础上联合小剂量雌激素,对比两组患者多毛、痤疮评分、性激素水平及性生活状态。结果:治疗后观察组患者多毛和痤疮评分分别为(4.94±2.73)分、(1.82±0.95)分,明显低于对照组患者;治疗后观察组患者睾酮、雌二醇、孕酮、促黄体生成素、促卵泡生成素水平分别为(1.28±0.30)nmol/L、(68.35±7.97)pmol/L、(13.36±2.07)m IU/m L、(8.24±1.23)m IU/m L,明显优于对照组患者;治疗后观察组患者性交干涩痛、性欲低下、性交频率下降比例分别为20.41%、26.53%、30.61%,明显低于对照组患者,差异具有统计学意义(P0.05)。结论:雌激素联合克罗米芬有助于改善患者性激素水平、改善患者性生活质量,促进患者临床症状缓解。     

Treatment of acne vulgaris. A comparison of doxycycline versus minocycline

In the course of a randomized, comparative, clinical study, 50 patients with acne vulgaris received systemic treatment with a single daily dose of 50 mg doxycycline or two daily doses of 50 mg minocycline. At the completion of the 12-week treatment, cure or improvement of acne was found in 78% of the patients in the doxycycline group compared to 82% in the minocycline group. The rate of unsatisfactory therapeutic results was 22% in the doxycycline group and 18% in the group of patients treated with minocycline. The results showed no significant difference between the clinical efficacy of treating acne vulgaris with doxycycline at a daily dose of 50 mg and 100 mg of minocycline daily, a fact which has already been demonstrated by earlier studies.     

Association between effective dose of prednisolone, alone or in conjunction with other immunosuppressants, and titre of anti-bullous pemphigoid 180 antibody: a retrospective study of 42 cases

Background. Corticosteroids, especially prednisolone or prednisone, are the most commonly used drugs for the treatment of bullous pemphigoid (BP). However, the appropriate initial effective prednisolone dose has not been established. Recently, a highly sensitive and specific ELISA for detection of autoantibodies to the non‐collagenous extracellular domain (NC16A) of the 180 kDa transmembrane hemidesmosome component [bullous pemphigoid (BP)180] was developed, and the titre of anti‐BP180 antibody was found to be closely related to disease activity. Aim. To investigate the relationship between anti‐BP180 antibody titre and effective prednisolone dose alone or in conjunction with other immunosuppressants. Methods. Anti‐BP180 antibody titres were measured by ELISA for the NC16A domain of BP180 in the sera of patients with BP (n = 42) at the start of treatment. The effective prednisolone dose was calculated from the patients’ records. Results. Higher anti‐BP180 antibody titres correlated with a higher effective prednisolone dose. In particular, patients with antibody titres > 200 required a significantly higher effective prednisolone dose than did those with antibody titres ≤ 200. Conclusions. A higher effective prednisolone dose may be necessary for patients who have both a high titre of anti‐BP180 antibody and severe clinical disease.     

Antiandrogens and acne

One hundred forty-four patients with acne, in most cases severe, were treated with cyproterone acetate, either at low dose ( Diane : 2 mg daily for 21 days), or at high dose ( Androcur : 50-100 mg daily for 10 days) in an inversed sequential schedule according to Hammerstein . The comparison between the two groups of patients exhibits an highly significant difference in favour of Androcur , as well on seborrhea as on comedones and eruptions, whatever the dose (50 or 100 mg); similarly, the results of Androcur were the same with or without topical treatment (Tretinoin or Benzoyl peroxide). The tolerance was equally good in the two groups.