X-linked ichthyosis: relation between cholesterol sulphate, dehydroepiandrosterone sulphate and patient's age

Steroid sulphatase deficiency is a feature of recessive X-linked ichthyosis (RXLI) that causes the accumulation of sulphated steroids (SS) in various organs and cells. In a previous study, we detected elevated cholesterol sulphate (CS) and dehydroepiandrosterone sulphate (DHEAS) serum levels in a group of 15 RXLI patients selected in a narrow age range. In the present study both CS and DHEAS serum levels were qualitatively and quantitatively determined using gas-chromatographic analysis in a group of 33 RXLI patients ranging in age from 3 to 70 years. The levels of CS and DHEAS were significantly increased in all patients. Variations in SS were related both to patients' ages and clinical course of the disease. Serum SS levels start to increase in early infancy, peak at puberty, remain elevated in adults and decrease slightly in the elderly.     

Hair care practices and structural evaluation of scalp and hair shaft parameters in African American and Caucasian women

How African American hair fragility relates to hair care practices and biologic differences between races is not well understood. To assess the differences between perceptions of hair health, hair care practices, and several biologic hair parameters between Caucasian and African American women. A questionnaire on perceptions of hair health and hair care practices was administered. Biological and structural parameters of hair shaft and scalp, including growth, density, diameter, cycle, breakage, and scalp blood flow were also assessed in this case–control study. Significant differences between the Caucasian and African American women were observed in the questionnaire and biologic study data. Regarding self‐reported perceptions of hair health, there were differences in the following: hair shaft type (P < 0.001), hair breakage (P = 0.040), and desire to change hair (P = 0.001). Regarding self‐reported hair care practices, there were differences in the following: location of haircutting (P = 0.002) and washing (P = 0.010), washing frequency (P < 0.001), chemical relaxer use (P < 0.001), hooded hair dryer use (P < 0.001), and hair shaft conditioner use (P = 0.005). The two groups had similar practices in regard to the use of hair color, frequency of hair color use, chemical curling agents, and handheld blow dryer use. Regarding biological and structural parameters, there were differences in the following: hair growth rate (P < 0.001), density (P = 0.0016), diameter (P = 0.01), number of broken hairs (P < 0.001), and blood flow (P = 0.03). There was no significant difference in hair cycle parameters.The differences in hair care practices and hair fiber morphology among African American women may contribute to clinically observed variation in hair fragility and growth.     

Baseline sebum IL‐1α is higher than expected in afro‐textured hair: a risk factor for hair loss?*

Objective To investigate changes in sebum cytokines in response to hair cosmetics. Design and setting A prospective study at a University hospital. Methods We used a novel method for scalp surface sebum collection (Sebutape^®) on three visits, sequentially a week apart, to investigate changes in six cytokines in 36 healthy women before and after shampoo and compared various chemical treatments (ammonium thioglycolate, “lye” sodium hydroxide and “no‐lye” guanidine hydroxide relaxers) performed by a professional hairdresser. Results Significant levels detected were IL‐1 alpha (IL‐1α) and IL‐1 receptor antagonist (IL‐1ra), which were higher in untreated scalp vs. forehead: P < 0.001. Baseline levels of scalp sebum IL‐1α were 18 times higher than IL‐1ra. The levels of IL‐1α decreased uniformly after shampoo (visit 1) and various chemical treatments (both crown and vertex all P < 0.001 – visit 2) but increased on follow‐up at visit 3. Decreases in IL‐1ra mimicked IL‐1α at the vertex [after shampoo (P = 0.018) and visit 3 (P = 0.014)], but not on the crown, a finding which may suggest site‐specific scalp predisposition to inflammation. The ratio of IL‐1ra/IL‐1α increased in all groups after all chemical treatments and on follow‐up (all P < 0.001) but was surprisingly not significantly different from natural hair that underwent shampoo. Limitations A wider cytokine panel may reveal response differences in treatment groups. Conclusions Baseline inflammatory scalp cytokines are higher than expected and reduce with shampooing. Scrutiny of the influence of hair moisturizer formulations and shampoo intervals and studies investigating pro‐fibrotic cytokines are required. This may elucidate the predilection of afro‐textured hair to scarring alopecia.     

Carrier identification in steroid sulphatase deficiency and recessive X-linked ichthyosis

Steroid sulphatase (STS) activity was measured with tritiated dehydroepiandrosterone sulphate (DHEAS) and oestrone sulphate (OES) in leucocytes as well as in skin fibroblasts from 31 women who were presumed to be carriers of STS deficiency and recessive X-linked ichthyosis. Overall, 30 of the 31 women (96.8%) could be identified as heterozygotes in at least one of the four assay systems used, i.e. on the basis of having an STS activity below the 2.5 percentile calculated for normal control females. In the individual assay systems, the highest carrier detection rate was achieved with OES in leucocytes (96.2%), followed by DHEAS in leucocytes (80.8%), whereas a more pronounced overlap was present in the fibroblast systems. In leucocytes as well as in fibroblasts, the STS activity determined with DHEAS was positively correlated with the STS activity determined with OES (p less than 0.001) suggesting that a single sulphatase is responsible for the hydrolysis of both steroid sulphates.     

Characteristic features of ageing in Korean women’s hair and scalp

Background The effect of age on hair properties has previously been investigated in white and Japanese women; however, little is known of the age‐related characteristic features of hair in Korean women. Objectives To determine the ageing features of Korean women’s hair by examining physical and biological factors in sufficient numbers of participants. Methods In total, 150 healthy Korean women (aged 23–69 years) living in Seoul were allocated to five age‐graded groups. Age‐related changes of various features of the scalp and hair shaft were measured, including hair density, diameter, tensile strength and lustre, and grey‐hair ratio. The hair‐shaft compositions of minerals, amino acids and steroid hormones were analysed by high‐performance liquid chromatography. Results Hair‐loss parameters (hair density, diameter and tensile strength) and hair lustre decreased significantly with age, beginning in the subjects’ 40s. The hair‐whiteness value increased significantly with age, beginning in their 60s, due to an increase in the ratio of grey hair. Calcium and magnesium levels greatly exceeded the reference ranges and declined in an age‐dependent manner, while potassium and phosphorus levels increased with age. No age‐related change of hair‐shaft amino acid content was evident. The contents of sterols and their metabolites (cholesterol, desmosterol, lanosterol and pregnenolone) increased significantly with age, but there was no correlation between the examined sex steroids and age. Conclusions  These results show that intrinsic ageing produces diverse changes in the hair and scalp features of Korean women from their 40s, and the ageing features of Korean women’s hair could be partially different from that of women in other countries.     

Deletion of the Sox21 gene drastically affects hair lipids

The effects of Sox21 gene deletion on hair lipids have been studied. For the cuticle‐specific bound lipid 18‐methyl eicosanoic acid (18‐MEA), which was found to predominantly exist as the free form in Sox21^?/? hair, total levels and distribution were unexpectedly unchanged. This indicates that while the biosynthesis of 18‐MEA is unaffected, its covalent attachment to the cuticle surface is disrupted by loss of keratin‐associated protein binding partners. Although the class compositions differed, the total ceramide (CER) levels were found to be comparable between Sox21^+/+ and Sox21^?/? hairs. Deletion of the gene was also found to increase cholesterol sulphate (CS) levels. The biosynthesis process might be associated with cuticle keratinocyte maturation, because both CS and CERs are known bioactives in keratinocyte differentiation.     

Hair shaft abnormalities after chemotherapy and tamoxifen therapy in patients with breast cancer evaluated by optical coherence tomography

Background Antineoplastic treatment for breast cancer is frequently associated with alopecia. Increasingly, changes in the texture and shape of regrowing hair after chemotherapy have been reported, without evaluation on a scientific basis. Optical coherence tomography (OCT) provides highly reproducible measurements of hair shaft parameters. Objectives This study aims to evaluate hair shaft alterations using OCT in chemotherapy‐induced alopecia and in patients taking tamoxifen. Methods The measurements of this prospective case series were performed on women aged 29–68 years, receiving either tamoxifen (n = 17) or chemotherapy (n = 17) prior to (T1) and after (T2) treatment. Each time, 20 hairs from two different sites of the scalp (frontal, occipital) were examined by OCT. The hair parameters were characterized by cross section (CS) and form factor (FF). The ratio of maximal to minimal hair diameters determined the FF. Results After chemotherapy, the CS of hairs was significantly lower compared with hairs taken at T1. The FF did not vary between T1 and T2 for the frontal area, but it did for the occipital area. In patients treated with tamoxifen, changes were observed neither in CS nor in FF. However, comparing both therapeutic groups, there were significant differences in CS and FF for T2, but not for T1. Conclusions Reported changes in hair structure after chemotherapy may be due to reduction of hair shaft calibre and increase of FF in regrowing hair. The OCT technique is a promising method to gain more insight into chemotherapy‐induced changes of hair morphology.     

Improvement in scalp hair growth in androgen-deficient women treated with testosterone: a questionnaire study

Background Androgens are thought to have an adverse effect on female scalp hair growth. However, our clinical experience of androgen replacement therapy in women with androgen deficiency, in which hair loss was seldom reported, led us to question this concept. Objectives To evaluate the effect of subcutaneous testosterone therapy on scalp hair growth in female patients. Methods A total of 285 women, treated for a minimum of 1 year with subcutaneous testosterone implants for symptoms of androgen deficiency, were asked to complete a survey that included questions on scalp and facial hair. Age, body mass index (BMI) and serum testosterone levels were examined. Results Out of the 285 patients, 76 (27%) reported hair thinning prior to treatment; 48 of these patients (63%) reported hair regrowth on testosterone therapy (responders). Nonresponders (i.e. no reported hair regrowth on therapy) had significantly higher BMIs than responders (P = 0·05). Baseline serum testosterone levels were significantly lower in women reporting hair loss prior to therapy than in those who did not (P = 0·0001). There was no significant difference in serum testosterone levels, measured 4 weeks after testosterone implantation, between responders and nonresponders. No patient in this cohort reported scalp hair loss on testosterone therapy. A total of 262 women (92%) reported some increase in facial hair growth. Conclusions Subcutaneous testosterone therapy was found to have a beneficial effect on scalp hair growth in female patients treated for symptoms of androgen deficiency. We propose this is due to an anabolic effect of testosterone on hair growth. The fact that no subject complained of hair loss as a result of treatment casts doubt on the presumed role of testosterone in driving female scalp hair loss. These results need to be confirmed by formal measurements of hair growth.     

Cholesterol sulphate levels in the hair and nails of patients with recessive X-linked ichthyosis

Cholesterol sulphate (CS) has been suggested as an intercellular glue for corneocyte-corneocyte cohesion from studies on patients with recessive X-linked ichthyosis (RXLI). Pathological stratum corneum of RXLI patients was found to show a significant elevation of CS. In the present study hair and nails, unaffected keratinized tissues in RXLI patients, were examined for CS levels. The results demonstrated significantly elevated CS levels in both tissues in RXLI patients (P less than 0.001). In particular the mean CS level in the hair of RXLI patients was five times greater than normal. The present study suggests that hair is a useful material for the diagnosis of RXLI.     

Distribution of polyamines may be altered in different scalp regions of patients with hair loss

Hair loss, from the vertex or front of the head, generally occurs due to increased androgenic steroid levels. Androgenic steroids, particularly testosterone and dihydrotestosterone, are distributed differently across the vertex and occipital regions and are involved in inducing ornithine decarboxylase expression. Therefore, we hypothesized that the distribution of polyamines may be altered in different scalp regions. For the overall metabolic profiling of polyamines in patients with hair loss, a liquid chromatography‐mass spectrometry was used. We investigated the differential polyamine levels in different regions of the hair of patients with male pattern baldness and those with female pattern hair loss. The levels of most polyamines were higher in the vertex region than in the occipital region, and N‐acetyl polyamine levels differed significantly. We proposed to test our hypothesis by profiling polyamines in human hair fibre to evaluate the distribution of metabolites in various regions of the scalp.     

Ovarian morphology and prevalence of polycystic ovary syndrome in reproductive aged women with or without mild acne

Background Acne and hirsutism are common manifestations of hyperandrogenemia. They may also be a sign of underlying severe diseases. Aim To compare ovarian morphology and prevalence of polycystic ovary syndrome (PCOS) in reproductive aged women with or without mild acne and hirsutism. Methods 52 women with mild acne and 59 age‐matched controls were included in this study. Main outcome measures were the prevalence of PCOS, ovarian morphology, and ovarian stromal thickness in both groups, and acne and hirsutism subgroups. Patients in both groups were taking no hormonal therapy at that time. Androgen profiles were compared between the two groups. Results The prevalence of PCOS was 17.1% (19/111) in all women included in this study. In the acne group, the prevalence of PCOS was 26.9% (14/52), and significantly more prevalent than in control group [8.4% (5/59), P = 0.001]. Total ovarian volume was significantly larger and stromal thickness of the ovary was thicker in women with acne than women without acne. There were no statistically significant difference between the two groups in terms of dehydroepiandrosterone sulfate, and 17‐hydroxyprogesterone, respectively, while serum total testosterone levels were significantly higher (P < 0.05) in women with acne than those women in the control group. Conclusions Acne and hirsutism may not only cause cosmetic concern but may also be a sign of underlying PCOS. Therefore, women presenting with acne and/or hirsutism should be evaluated in terms of PCOS.     

Physiological changes in scalp, facial and body hair after the menopause: a cross-sectional population-based study of subjective changes

Background Significant changes in scalp, facial and body hair occur after the menopause. These can have a significant negative impact on self‐esteem and are also potential markers of endocrine or metabolic diseases. Knowledge of postmenopausal hair changes is important for clinicians to distinguish between normal physiological change and those that require further medical investigation. Objectives To assess the subjective experience of scalp, facial and body hair change in a large cohort of normal postmenopausal females. Methods Postmenopausal females aged 45 years or over of northern European origin completed a questionnaire detailing scalp, facial and body hair changes following the menopause. Women with a history of thyroid disease, oophorectomy or premature menopause were excluded from the study. The Mann–Whitney U‐test and the χ² test were used to assess the correlation between scalp, facial and body hair changes with age. Results Diffuse generalized hair loss was the most common form of scalp hair loss, reported by 26% of women. Frontal hair loss was reported by 9% of women. Facial hair gain was cited by 39% of females with the chin being the most frequent site for new growth (32% of women). Body hair loss was significantly correlated with older age (P < 0·001) and was most frequent at androgen‐sensitive sites. We noted two patterns: (i) diffuse hair loss in which diffuse generalized scalp hair loss was significantly correlated with body hair loss and increasing age (P < 0·05); and (ii) frontal hair loss which was associated with higher facial hair scores and relatively younger age (P < 0·05) compared with women with diffuse hair loss. Conclusions This is the first comprehensive study of the subjective hair changes in postmenopausal women. This study demonstrates two distinct patterns of hair change relating to age, which may reflect different underlying pathophysiological mechanisms and are of relevance to the medical management of these women as well as being possible predictors of health outcomes.     

Correlation between serum levels of insulin-like growth factor 1, dehydroepiandrosterone sulfate, and dihydrotestosterone and acne lesion counts in adult women

OBJECTIVES: To determine if insulin-like growth factor 1 (IGF-1) and androgen levels (1) correlate with the presence and severity of acne in adult men and women, and (2) correlate directly with each other and interact in affecting acne. DESIGN: Case-control study and single-center examination of hormone levels in a cohort of volunteers. SETTING: Academic referral center. PATIENTS: Thirty-four subjects (8 women and 8 men with clinical acne, 10 women and 8 men without clinical acne). Clinical acne is defined by a history of persistent acne (acne present on most days for several years), recent acne treatment, and the presence of 10 or more inflammatory acne lesions and 15 or more comedones. INTERVENTIONS: Single visit for serum sampling. MAIN OUTCOME MEASURES: Serum levels of IGF-1 and androgens were determined, adjusted for age, and compared based on the presence or absence of clinical acne using an analysis of covariance. Correlations between hormone levels and acne lesion counts were calculated within each subgroup. Correlations were also calculated between serum levels of IGF-1 and androgens. Further statistical testing was conducted to determine whether IGF-1 or androgens had a greater effect on acne lesion counts. RESULTS: Dehydroepiandrosterone (DHEAS), dihydrotestosterone (DHT), and IGF-1 correlated positively with acne lesion counts in women. Androstenedione and DHEAS correlated with acne lesion counts in men. Although the age-adjusted mean serum levels of IGF-1 were higher in women with clinical acne than in women without clinical acne, this difference did not achieve statistical significance. No difference in IGF-1 level was noted in men based on the presence of clinical acne. In women with clinical acne, IGF-1 correlated with DHT. In men with clinical acne, IGF-1 correlated with DHEAS and androstenedione. In men and women with clinical acne, the effects of androgens on increased acne lesion counts were dependent on the influence of IGF-1. CONCLUSIONS: Increased IGF-1 levels in addition to androgens may influence acne in adult men and women. While IGF-1 appears to have a stronger effect on acne in women, androgens may play a greater role in acne for men. However, in both men and women these hormones are interrelated, possibly owing to reciprocal effects on hormone production.     

青春期后女性痤疮与慢性应激及雄激素水平的相关性研究

目的 研究青春期后女性痤疮患者的皮损总数、严重程度、生活质量与慢性应激、肾上腺源性雄激素水平的相关性。方法 100例26 ~ 45岁女性受试者（50例痤疮患者和50例正常对照）被纳入到该研究。通过单次血清采样，用放射免疫的方法测定受试者血清硫酸脱氢表雄酮（DHEAS）、皮质醇水平。同时用生活事件量表对受试者的慢性应激进行定性与定量；用皮肤病生活质量指数测定痤疮对患者生活的影响；用痤疮皮损计数法和痤疮综合分级系统记录患者皮损总数和严重程度。结果 病例组生活事件（总分值189.7 ± 36.5）、血清DHEAS（140 ± 30 μg/L）和皮质醇（348 ± 88 μg/L）水平均显著高于对照组（生活事件总分值104.3 ± 13.3、血清DHEAS 110 ± 17 μg/L、皮质醇142 ± 85 μg/L），两组比较，P 均 < 0.01。病例组的生活事件与血清DHEAS（r = 0.34，P < 0.05）、皮质醇（r = 0.44，P < 0.01）、痤疮皮损总数（r = 0.29，P < 0.05）呈显著正相关；DHEAS水平与痤疮皮损总数呈显著正相关（r = 0.54，P < 0.01）。病例组皮损总数、严重程度均与皮肤病生活质量指数有显著相关性（均为P < 0.01）。结论 青春期后女性痤疮的发病及皮损总数与慢性应激及其导致的肾上腺源性雄激素升高存在相关性。患者的皮肤病生活质量与皮损总数及严重程度相关。对于此期患者，除常规治疗之外需要对抗雄激素的治疗及心理治疗。     

Short‐term isotretinoin treatment decreases insulin‐like growth factor‐1 and insulin‐like growth factor binding protein‐3 levels: does isotretinoin affect growth hormone physiology?

Summary Background Isotretinoin is an effective treatment for acne vulgaris. However, it has numerous side‐effects. It was previously reported that serum growth hormone (GH) levels decreased with isotretinoin treament. Objectives To analyse whether isotretinoin has any effects on insulin‐like growth factor‐1 (IGF‐1), insulin‐like growth factor binding protein‐3 (IGFBP3) and GH levels. Methods Forty‐seven patients aged 21·5 ± 5·1 years (mean ± SD) with acne vulgaris were included in this study. Isotretinoin therapy was initiated at a dose of 0·5–0·75 mg kg^?1 daily and then adjusted to 0·88 mg kg^?1 daily as maintenance dosage after 1 month. Screening for biochemical and hormonal parameters was performed just before initiation and after 3 months of isotretinoin treatment. Results IGF‐1 and IGFBP3 levels decreased significantly after treatment (P < 0·01), while GH levels did not change. Post‐treatment, significant increases were seen in aspartate aminotransferase, total cholesterol, low‐density lipoprotein cholesterol, triglycerides and low‐density lipoprotein cholesterol/high‐density lipoprotein cholesterol ratio (P < 0·0001) while high‐density lipoprotein cholesterol levels were significantly decreased (P < 0·0001). Conclusions Isotretinoin therapy may have an effect on GH physiology, and further studies are needed to understand this association.     

Clinical, ultrasound and hormonal markers of androgenicity in acne vulgaris

Androgenic stimulation of sebaceous glands is an important factor in the development of acne. We examined 36 females (aged 14-34 years), selected because none had received oral contraceptives, anti-androgen therapy, or systemic antibiotics during the previous year, or isotretinoin therapy, prior to their participation in the study. Subjects were divided into groups on the basis of acne severity, as follows: physiological, mild and moderate. Only two patients had polycystic ovaries on ultrasound examination. Seven patients had irregular menses; none had evidence of hirsutism. We found that the severity of acne, based on the acne grade, was highly correlated with the inflammatory lesion count, and less correlated with the sebum excretion rate. Either acne grade or inflammatory lesion count could be related to some of the five androgenic hormone determinants; free testosterone (TESTOS), δ4 androstenedione (DELTA 4), sex hormone binding globulin (SHBG), dehydroepiandrostenedione sulphate (DHEAS) and dihydrotestosterone (DHT). Multiple linear regression analysis determined the best model for predicting ACNE score as involving DELTA 4 and DHEAS (positive effects), and SHBG (negative effect), P < 0.005, R²= 0.36). In none of the patients were the levels of DHEAS or SHBG outside the normal range. The flndings in the two patients with polycystic ovaries did not differ signiflcantly from those in the remainder of the patients.     

STUDIES ON THE QUANTITY AND CHEMICAL COMPOSITION OF SURFACE LIPIDS OF HUMAN SCALP AND HAIR

The quantity and chemical composition of the surface lipids of the normal female scalp and hair were studied.

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Adrenal androgen abnormalities in women with late onset and persistent acne

Androgens are an essential prerequisite for the development of acne. The present study was undertaken to characterize the androgen status of women with late onset and persistent acne only and, using the dexamethasone (dex) suppression test, to identify the source(s) of the androgen excess. We measured serum levels of total testosterone (T), free testosterone (FT), androstenedione ( ⁴A), dihydrotestosterone (DHT), dehydroepiandrosterone sulphate (DHEA-S) and sex hormone binding globulin (SHBG) in 34 healthy control subjects, in 34 women with mild acne and in 29 women with moderate or severe acne. Serum FT, DHT and DHEA-S levels in patients of both acne groups were significantly higher than those in the control subjects. The other hormone levels showed no significant differences between patients and control subjects, and there were no significant differences between the two acne groups in any of the androgen levels. In order to evaluate the ovarian and adrenal contributions to serum androgens in the acne patients, the serum levels of ⁴A, T, DHT and DHEA-S were measured prior to and following 2 weeks of dex therapy. Following the dex test, the DHT and T of adrenal origin were significantly higher in the acne patients than in the control subjects. These results suggest that, in acne patients, hyperandrogenaemia is likely to develop as a result of adrenal androgen excess. In addition, since abnormally high androgen levels are frequently seen in late onset and persistent acne, it seems that this condition is likely to be a sign of hyperandrogenism.     

An observational study of methionine‐bound zinc with antioxidants for mild to moderate acne vulgaris

APC is a novel methionine‐based zinc complex with antioxidants that has been used in acne as a nutritional supplement. This is based on the proven role of zinc and antioxidants in improving acne, specially the inflammatory lesions. The objectives of this study are to explore the efficacy, safety, and tolerability of APC in acne patients with mild to moderate facial acne vulgaris. In this exploratory trial, 48 patients were treated with oral APC thrice a day for 3 months followed by a 4‐week treatment‐free period. At the end of treatment (Week 12), there was a statistically significant improvement in the global acne count (p < 0.05), which began after 8 weeks (p < 0.05). Almost 79% (38/48) of the patients had 80–100% improvement. There was a significant reduction in pustules (8 weeks (p < 0.05) and 12 weeks (p < 0.001)), and papules and closed comedones (8 weeks (p < 0.05) and 12 weeks (p < 0.001)). Only two patients had side effects. The current data indicate that treatment with oral APC thrice daily for 12 weeks in patients with mild to moderate facial acne vulgaris is efficacious and well tolerated. As the onset of action is late, concomitant topical therapy can enhance the results.     

Effects and side-effects of spironolactone therapy in women with acne

BACKGROUND AND AIMS: Androgen hormones play an important role in the pathogenesis of acne. Despite the demonstrated effects, spironolactone, an androgen receptor blocker, is not commonly used to treat acne. We planned an open-labelled, prospective study to evaluate the effects and side-effects of spironolactone therapy in women with acne. MATERIALS AND METHODS: Thirty-five consecutive patients with acne were treated with spironolactone 100 mg/day, 16 days each month for 3 months. The patients were divided according to the clinical severity of the lesions as having mild, moderate and severe acne. Serum total testosterone and dehydroepiandrosterone sulfate (DHEAS) levels were measured before and after treatment. Lesion numbers and hormone levels before and after treatment were compared with one-sampled t-test. RESULTS: The mean age of the patients was 21.4 +/- 3.5 years. Two patients discontinued the study due to side-effects. Five patients were lost in the follow-up. Clinically significant improvement was noted in 24 patients (85.71%). No response was seen in four patients. All of the nonresponding patients had received previous unsuccessful therapies. Mean number of lesions and mean DHEAS levels of the 24 patients with clinical improvement decreased significantly after treatment (P < 0.01 and P < 0.05, respectively). There was no change in the mean total testosterone levels before and after treatment (P > 0.05). CONCLUSION: Spironolactone is a safe and effective medication for women with acne vulgaris. Although its side-effects seem to be high, they are in the majority of cases not a reason to stop treatment.