The frequency of polycystic ovary syndrome in females with resistant acne vulgaris

Background Acne vulgaris in females may be resistant to treatment in spite of topical and systemic therapy for a sufficient period. In this condition, acne may be a manifestation of underlying endocrine conditions such as polycystic ovary syndrome (PCOS). Objective To evaluate the frequency of PCOS in females with resistant acne vulgaris. Patients and methods This case‐controlled study was conducted in the Department of Dermatology and Venereology in The Teaching Hospital in Al‐Najaf during the period from October 2007 to November 2008. One hundred and twenty‐three female patients with resistant acne vulgaris were included in this study. One hundred and twenty‐three women, age‐matched, without acne were enrolled as a control group. Detailed history, clinical examination, abdominal ultrasound study, and hormonal assays were obtained for the patients and the control group. Results One hundred and twenty‐three females with resistant acne were included; their ages ranged from 17 to 40 years with a mean of 25.016 ± 6.041 (SD). One hundred and twenty‐three control women without acne were enrolled; their ages ranged from 17–40 years with a mean of 26.014 ± 6.251 (SD). The patients and the control group are age‐matched (P = 0.192). It was found that 63 patients (51.2%) with resistant acne have PCOS in comparison to only eight control women (6.2%). The difference is highly significant. Conclusion Polycystic ovary syndrome is an important contributing factor in females with resistant acne vulgaris.     

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。     

中性粒细胞与淋巴细胞比值联合超敏C-反应蛋白在寻常型银屑病合并多囊卵巢综合征中的诊断价值

目的探讨中性粒细胞和淋巴细胞比值(NLR)联合超敏C反应蛋白(hs-CRP)在寻常型银屑病(Psoriasis vulgaris,PV)合并多囊卵巢综合征(PCOS)中的诊断价值。方法回顾性纳入本院妇产科住院的31例PV合并PCOS的患者、76例皮肤科门诊PV患者和55例体检中心正常体检人群作为研究对象,记录所有研究对象血常规指标及hs-CRP水平。比较3组研究对象血常规指标和hs-CRP水平的差异,有统计学意义的变量与PV合并PCOS患者的病程、睾酮水平及LH/FSH采用Spearman相关性分析,并采用Logistic回归分析PV合并PCOS的独立变量,利用受试者操作曲线探讨NLR联合hs-CRP在PV合并PCOS中的诊断价值。结果PV合并PCOS患者血NLR、hs-CRP较PV患者显著升高(均P<0.05),PV患者血NLR、hs-CRP较正常对照组显著升高(均P<0.05)。Logistic回归分析结果显示NLR、hs-CRP是PV合并PCOS的独立相关变量(P<0.05)。受试者工作特征(ROC)曲线显示NLR联合hsCRP对PV合并PCOS有良好的诊断价值,其敏感度为94.8%,特异性为75.6%。结论PV患者应常规检测NLR和hs-CRP水平,NLR和hs-CRP联合检测对PV合并PCOS有良好的诊断价值。     

Profiling and Hormonal Therapy for Acne in Women

Acne vulgaris is the most common condition treated by physicians worldwide. Though most acne patients remit spontaneously, for the ones that do not or are unresponsive to conventional therapy or have obvious cutaneous signs of hyperandrogenism, hormonal therapy is the next option in the therapeutic ladder. It is not strictly indicated for only those patients who have cutaneous or biochemical evidence of hyperandrogenism, but can be used even without any evidence of hyperandrogenism, for therapy-resistant acne. It can be prescribed as monotherapy, but when used in combination with other conventional therapies, it may prove to be more beneficial. Hormonal evaluation is a prerequisite for hormonal therapy, to identify the cause behind hyperandrogenism, which may be ovarian or adrenal. This article reviews guidelines for patient selection and the various available hormonal therapeutic options, their side-effect profile, indications and contraindications, and various other practical aspects, to encourage dermatologists to become comfortable prescribing them.     

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 severity of the disease is not well established. OBJECTIVES: The aim of our study was to evaluate the relationship between acne severity and the clinical and laboratory markers of androgenicity in a large 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) were measured. Menstrual cycle regularity, hirsutism score, acne severity and ultrasound evaluation of polycystic ovaries were recorded. One-way analysis of variance, chi(2)-test and correlation analysis were used for data processing. RESULTS: Hirsutism was documented in 19 (21%) subjects, elevated levels of at 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 was 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 correlation between the grade of acne severity and any of the clinical or laboratory markers of androgenicity assessed. On the contrary, women with a higher grade 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 adult women is not determined by androgen production.     

Diagnosis and management of the dermatologic manifestations of the polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a complex phenotypic spectrum of primarily hyperandrogenic signs and symptoms. PCOS is the most common endocrine disturbance to affect women of reproductive years. Although patients affected are often very disturbed by the cutaneous manifestations, including acne, hirsutism, alopecia, obesity, and acanthosis nigricans, the clinical manifestations of PCOS ramify far beyond the skin. PCOS frequently causes menstrual abnormalities and infertility. Insulin resistance is both pathogenic and a cause of numerous serious health consequences. The accurate diagnosis and recognition of cutaneous hyperandrogenism in PCOS are discussed. The differential diagnosis is reviewed. The work-up and approach to evaluation of patients with PCOS is presented. Although no uniform treatment approach for the management of the cutaneous manifestations of PCOS has been agreed upon, the data on various treatment options and the author's treatment approach to these patients are presented.     

Androgen Status in Adolescent Women with Acne Vulgaris

Androgens are essential for the development of acne. The object of this study was to elucidate the androgen status of women with adolescent (Tanner's stage IV–V) acne alone and compare them to age-matched normal controls. We measured serum levels of total testosterone (T), free testosterone (FT), dihydrotestosterone (DHT), and dehydroepiandrosterone sulfate (DHEA-S) in 15 women with adolescent acne and 13 age-matched healthy controls. No significant differences were found between the mean levels of T, FT or DHT levels in patients and controls. However, the mean levels of DHEA-S in the patient population (1886 ± 829 ng/ml) were significantly (p<0.05) higher than normal controls (1287 ± 620 ng/ml). There was also no correlation between androgen levels and acne severity. Thus it is unlikely that serum androgens play a principal role in women with adolescent acne.     

Acne: prevalence, perceptions and effects on psychological health among adolescents in Aydin, Turkey

Background Acne vulgaris is a common disease among adolescents and known to have adverse effects on psychological status. Methods A cross‐sectional study was conducted on 600 participants by means of a questionnaire designed for this study in high school students. In addition, an objective evaluation of acne in participants was undertaken. The questionnaire consisted of questions about acne, General Health Questionnaire (GHQ) and Rosenberg Self‐Esteem Scale (RSES). Results Five hundred and sixty‐three questionnaires out of 600 were answered and 550 adolescents who gave permission for examination were evaluated. The study population consisted of 303 girls and 260 boys between the ages 13 and 19, and the mean age was 15.24 ± 1.05 years. Acne prevalence was 63.6% with 29.2% non‐inflammatory and 34.4% inflammatory acne. It was more prevalent and severe in boys than in girls. Not the objective but the subjective severity of acne and opinion that one could benefit from acne treatment was found to be related to anxiety, depression and self‐esteem. Factors implicated among causes of acne were food, bad skin hygiene and hormones in decreasing frequency. Forty‐eight per cent of adolescents expect a maximum duration of 4 weeks for treatment. Conclusion Despite the high prevalence of acne, there is still much deficiency of knowledge and wrong beliefs about acne. This indicates that there is an urgent need for education about etiopathogenesis, potential complications and importance of effective treatment for acne. Effective treatment may make significant contributions for the mental health of adolescent and as well as adult populations.     

Successful treatment of one case of pemphigoid gestationis complicating with polycystic ovary syndrome

Pemphigoid gestationis (PG) is a rare, autoimmune, subepidermal bullous dermatosis associated with pregnancy. It is mainly caused by autoantibodies against hemidesmosomal proteins‐bullous pemphigoid 180, and usually presents in the second or third trimester of pregnancy sometimes exacerbates spontaneously after delivery. Here we reported a case of PG with polycystic ovary syndrome (PCOS). This patient received assisted reproduction technology and suffered PG in her third trimester of pregnancy. To the best of our knowledge, there is no similar case has been reported.     

多囊卵巢综合征临床特征和某些内分泌激素的检测

目的：比较肥胖和非肥胖性多囊卵巢综合征（PCOS）患者的皮肤病学特征和性激素水平的差异。方法：依据BMI标准将患者分为肥胖组（41例）和非肥胖组（75例）,对各组中每个妇女进行体质评估,包括体型、痤疮、多毛症、皮脂溢出、雄激素性脱发和黑棘皮病。logistic多元回归分析皮肤病学特征与激素和代谢参数的相关性。结果：肥胖和非肥胖组痤疮的发生率分别为5．2％和40．5％,多毛症为29．3％和37．0％,皮脂溢出为14．7％和22．4％,雄激素性脱发为14．7％和24．1％,黑棘皮病为1．7％和4．3％。与非肥胖组比较,肥胖组PCOS月经减少、经期延长,睾酮水平明显增高。结论：肥胖PCOS患者会出现更多的皮肤症状和排卵障碍。     

Mild Insulin Resistance during Oral Glucose Tolerance Test (OGTT) in Women with Acne

The purpose of this study was to evaluate serum levels of basal insulin and glucose-stimulated insulin, and to evaluate their correlations with androgen levels in women with acne. Serum levels of total testosterone (T), free testosterone (FT), dihydrotestosterone (DHT), dehydroepiandrosterone sulfate (DHEA-S), sex hormone binding globulin (SHBG), insulin-like growth factor-1 (IGF-1), and immunoreactive insulin (IRI) were measured and compared in thirty women with moderate or severe acne and thirteen healthy controls. Serum FT, DHT and DHEA-S levels in the acne group were significantly higher than those in the control group. In the acne group, there were no significant correlations between insulin or IGF-1 levels and T, FT, DHT and SHBG, despite the positive correlation between insulin and IGF-1. In order to determine the effects of insulin secretion as a dynamic response to an oral glucose tolerance test (OGTT) on serum androgen levels in acne patients, we examined the responses of serum insulin and androgen levels to a 75 g, 2 hour OGTT in the acne group and in the control group. Basal insulin levels were not significantly higher than those in the control group, but the summed insulin levels during the OGTT in the acne group were significantly higher than those in the control group. Serum T and FT levels in the acne group decreased during the OGTT, but these changes were not so significant when compared to normal controls. In conclusion, we tried to demonstrate mild insulin resistance during the OGTT in acne patients. However, postmeal transient hyperinsulinemia does not seem to play an important role in determining hyperandrogenemia in acne patients.     

Prevalence of Acne Inversa (Hidradenitis Suppurativa) in China: A Nationwide Cross-Sectional Epidemiological Study

Objective::This study was performed to estimate the prevalence of hidradenitis suppurativa (HS) in China and describe the demographic and clinical features of H...     

Elevated Serum Insulin-like Growth Factor-1 (IGF-1) Levels in Women with Postadolescent Acne

The purpose of this study was to measure the serum levels of IGF-1 in women with postadolescent acne compared to normal controls, and evaluate the relationship of these levels to the levels of androgens, in order to investigate the possible role of IGF-1 in the pathogenesis of acne. Eighty-two female patients with acne between 20 and 25 years of age and thirty-one age-matched control women were studied. We measured the serum levels of total testosterone (T), free testosterone (FT), dihydrotestosterone (DHT), dehydroepiandrosterone sulfate (DHEA-S), and insulin-like growth factor-1 (IGF-1). The levels of IGF-1 in patients with acne (1.26 ± 0.52 U/ml) were significantly (p<0.001) increased over those of controls (0.96 ± 0.32 U/ml). Of 82 acne patients, six (7%) had IGF-1 levels which exceeded the normal range, but there were no significant correlations between IGF-1 and T, FT, DHT or DHEA-S levels or between IGF-1 and acne severity. Since the measurement of serum IGF-1 levels is a convenient indicator of GH secretion, the increase of serum IGF-1 levels seen in some acne patients might reflect an increase of GH.     

Management of acne vulgaris with hormonal therapies in adult female patients

Acne vulgaris is a very common condition affecting up of 93% of adolescents. Although rare, this disease may persist in adulthood. In adult women with acne (those older than 25 years old), this condition is particularly relevant because of the refractory to conventional therapies, which makes acne a challenge for dermatologists in this group of patients. In order to its potential risk for chronicity and the involvement of visible anatomical sites such as face and upper torso, acne has been associated with a wide spectrum of psychological and social dysfunction such as depression, anxiety, suicidal ideation, somatization, and social inhibition. In particular, adult women with acne have been shown to be adversely impacted by the effect of acne on their quality of life. For the last four decades, dermatologists have used hormonal therapies for the management of acne vulgaris in adult women, which are considered a rational choice given the severity and chronicity of this condition in this group of patients. The aim of this work is to review the hormonal drugs for management of acne.