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.     

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.     

Assessment of androgens in women with adult-onset acne

BACKGROUND: Acne is generally recognized as a disorder of young adults; however, the referral of patients aged over 25 years with acne is increasing. Disturbed androgen production in the ovaries or adrenal gland and impaired plasma transport of androgens in women with adult-onset acne or acne associated with hirsutism have been described. METHODS: Thirty-five white women with adult-onset acne (onset after the age of 25 years) and hirsutism (A + H), 35 white women with adult acne without hirsutism (A - H), and 35 age-matched white female controls were recruited in this case-control study. Serum levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), total testosterone, dihydroepiandrosterone sulfate (DHEA-S), and sex hormone binding globulin (SHBG) were determined in all patients and compared. RESULTS: The mean SHBG, free androgen index (FAI), and DHEA-S were significantly different between A + H and control subjects. The only significant difference between A - H and control subjects was observed for DHEA-S. CONCLUSION: DHEA-S plays a key role in the pathogenesis of adult-onset acne. Measurement of circulating androgens, including DHEA-S, especially in patients presenting with adult-onset acne and hirsutism, is helpful, and patients with elevated levels can benefit from hormonal therapy.     

Serum hormone levels in men with severe acne.

In order to evaluate the hormonal milieu in young men with severe acne, we measured serum estradiol (E2), total testosterone (T), free testosterone (FT), dihydrotestosterone (DHT), dehydroepiandrosterone sulfate (DHEA-S), and sex hormone binding globulin (SHBG) levels in sixteen male patients aged 20-30 years with severe acne, including twelve cases of nodular-cystic acne, and in seventeen age-matched normal controls. There were no significant differences in the serum levels of T, FT, DHT, DHEA-S, or SHBG between the patients and the controls, but serum E2 was significantly higher in the patient population. Thus, the hemodynamics of serum androgens in male patients with acne do not seem to differ significantly from that of normal controls. Elevated E2 levels might affect the inflammatory response of acne vulgaris through the release of thymic hormones, as reported in the literature.     

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.     

Influence of oral metronidazole on the endocrine milieu and sebum excretion rate.

As part of a study of the mechanism of metronidazole's efficacy in the treatment of acne and rosacea, its effects on the endocrine milieu and sebum excretion rate were assessed. Thirteen healthy males received oral metronidazole treatment (500 mg/day) for 4 weeks. Serum sex hormone levels were determined in all 13 subjects and the sebum excretion rate was determined in seven of them, before and after treatment. We measured serum levels of estrone (E1), estradiol (E2), total testosterone (T), free testosterone (FT), dihydrotestosterone (DHT), dehydroepiandrosterone sulfate (DHEA-S), and sex hormone-binding globulin (SHBG). There were no significant changes in E1, T, FT, DHT, or SHBG levels, but E2 and DHEA-S levels decreased significantly after treatment. In all seven subjects in whom the sebum excretion rates were determined, the amount of facial skin surface lipids decreased significantly after treatment. These results suggest that metronidazole exerts its clinical effects through suppressing the sebum excretion by a mechanism other than anti-androgenic action.     

Intranuclear androgen and cytosolic receptor concentrations in the axillary skin of osmidrosis

Summary 5-Dihydrotestosterone (DHT) and testosterone were measured by radioimmunoassay in the crude nuclear and cytoplasmic fractions of the axillary skin of both male and female patients with osmidrosis and the levels compared with those of nongenital skin. The intranuclear levels of DHT were 1.44±0.22 and 1.77±0.38 pg/g DNA in men and women, respectively. Those of testosterone were about 10% of DHT levels. In the skin of nontarget regions nuclear DHT was much scarcer or undetectable. Cytosolic androgen receptors in isolated apocrine glands were also measured using ³H-R1881 as a ligand. Typical androgen receptors were present in all of eight patients (K_D=1.32 ±0.24×10^–9M, B_max=10.3±0.51 fmol/mg protein). Neither the intranuclear androgen concentrations nor the cytosolic androgen receptor levels were significantly different between the two sexes. These data indicate clearly that the apocrine gland of patients with osmidrosis is a typical androgen target organ, irrespective of sex, and suggest that nuclear DHT in the axillary skin of women is derived from not only testosterone but also other precursors, especially in consideration of the very low serum concentrations of testosterone in females.     

Serum Sex Hormone Levels in Adult Patients with Atopic Dermatitis

Serum levels of sex hormones were measured in adult patients with atopic dermatitis (AD) and compared with those in sex- and age-matched healthy controls. In 40 male patients with AD, serum levels of testosterone (T) (447 ± 96 vs 593 ± 149 ng/dl, P<0.001), free testosterone (FT) (14.6 ± 3.2 vs 20.0 ± 5.1 pg/ml, P<0.001) and estradiol (E₂) (27.2 ± 7.2 vs 33.2 ± 7.9 pg/ml, P<0.05) were significantly lower and serum levels of luteinizing hormone (LH) (4.57 ± 1.6 vs 3.11 ± 1.2 mIU/ml, P<0.001) were significantly higher than those in healthy controls. There were no significant differences in serum levels of dihydrotestosterone (DHT), dehydroepiandrosterone sulfate (DHEA-S), dehydroepiandrosterone (DHEA), or follicle stimulating hormone (FSH) between the two groups. In 25 female patients with atopic dermatitis, T, FT, DHT and DHEA-S levels did not differ from controls. In conclusion, serum T levels were lower in male patients with AD. However, similar changes were not seen in female patients.     

Association of thyroid autoimmunity with acne in adult women

Background During the last decades an increase has been observed regarding acne in adults and especially women. Objective To evaluate the association between thyroid disorder and the presence of post‐adolescent acne in adult women, comparing with healthy controls. Methods 107 adult women with post–adolescent acne and 60 healthy controls were included. Complete blood count and standard biochemical profile of C‐Reactive Protein (CRP) and levels of thyroid hormones and antibodies [triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH), free T3 (FT3), free T4 (FT4), antithyroglobulin antibodies (anti‐TG) and anti‐thyroid peroxidase antibodies (anti‐TPO)] were determined in all subjects of both the acne and control groups. A thyroid ultrasound was also performed. Results There was a statistically significant difference (P = 0.008) in the prevalence of positive anti‐TG antibodies, with 25.2% of the acne group and 8.3% of the control group having elevated (> 40 U/mL) anti‐TG levels, respectively. Adult women with acne had a statistically significant increased relative risk to have high levels of anti‐TG in comparison with healthy controls (odds ratio 3.89, P = 0.011). This association was independent of age. Values for TSH, FT4, FT3, T4 and anti‐TPO did not significantly differ between the two groups. No significant difference was found regarding the thyroid ultrasound findings. Although there was no significant difference between cases and controls regarding CRP levels, it is interesting that we observed a significant elevation in CRP in those acne patients who had positive antithyroglobulin antibodies. Conclusions It is likely that thyroid autoimmunity might be more frequent in the adult acne patients and this should be kept in mind when screening women with post‐adolescent acne.     

The clinical evaluation of hirsutism

Hirsutism is a disorder of excess growth of terminal hairs in androgen-dependent areas in women. Other cutaneous conditions associated with androgen excess are androgenetic alopecia, acanthosis nigricans, and acne. Hirsutism is often associated with measurably elevated androgen levels, but not in all cases. Androgens in women arise from the ovary and adrenal glands, and peripherally from skin and fat. The most common cause of hirsutism is polycystic ovarian syndrome. Patients with "idiopathic" hirsutism have normal ovulatory cycles and androgen levels. Other causes are late onset congenital adrenal hyperplasia, Cushing's syndrome, and the HAIR-AN syndrome. Pituitary, ovarian, and adrenal tumors are important, but rare causes of hirsutism. A thorough history and examination are important. Laboratory investigation is essential in women with moderate to severe, sudden onset or rapidly progressing hirsutism. Identification of the underlying etiology does not alter management, but detects patients at risk for infertility, diabetes, cardiovascular disease and endometrial carcinoma.     

Congenital adrenal hyperplasia and acne in male patients

Seborrhoea is one pathogenic factor for acne. Androgens induce sebum production, and excess androgen may provoke or aggravate acne. In women an androgen disorder is frequently suspected when acne is accompanied by hirsutism or menstrual irregularities. In men acne may be the only symptom of androgen excess. We report three male acne patients in whom hormonal screening revealed irregularities of androgen metabolism suggestive of late-onset congenital adrenal hyperplasia and who benefitted from low-dose glucocorticoids. Disorders of androgen metabolism may influence acne not only in women, but also in men, and these patients may benefit from low-dose glucocorticoid therapy.     

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.     

Skin improvement with two different oestroprogestins in patients affected by acne and polycystic ovary syndrome: clinical and instrumental evaluation

Background Despite it is accepted that acne is mostly caused by an hyper‐responsiveness of the pilo‐sebaceous unit to normal circulating androgen hormones, in a few patients, especially women, acneic lesions can be associated with increased serum androgen levels (hyperandrogenism), of which polycystic ovary syndrome (PCOS) is the most common cause. In women with acne and proven PCOS therapy with estroprogestins (EPs) can be an excellent option. Objective The aim of the study was to assess the effects of two estroprogestins (EPs), ethinyl‐estradiol (EE) 30 mcg/drospirenone (DRSP) 3 mg, and ethinyl‐estradiol (EE) 30 mcg/chlormadinone acetate (CMA) 2 mg, both on increased serum androgen levels and on several skin parameters in women affected by mild to severe acne and polycystic ovary syndrome (PCOS). Methods Fifty‐nine women were randomized to receive EE/DRSP (n = 32) or EE/CMA (n = 27) for six months. Evaluation of serum androgen levels, grading of acne and hirsutism (respectively with Pillsbury and Ferriman‐Gallwey score) and non‐invasive assessment of skin hydration, transepidermal water loss (TEWL) and skin homogeneity were performed at baseline, at 3 and 6 months (end of treatment). Results Both treatments were well tolerated and showed a significant improvement of skin and hormonal parameters, although EE/DRSP showed a more potent effect on acne and seborrhea. Conclusions Estroprogestins represent an effective and safe treatment in women with acne and polycystic ovary syndrome (PCOS). Nevertheless, the combination EE 30 mcg/DRSP 3 mg appears to be a more potent therapeutic option.     

Acne: effect of hormones on pathogenesis and management

In the pathogenesis of acne, androgen hormones play a crucial role. In the treatment of acne, hormonal therapies provide valuable alternatives to standard modalities in selected women. Although numerous factors contribute to the development of acne, the requirement for androgens is absolute and is one that allows for effective treatments in women through inhibition of androgen expression. The two prerequisites for androgen expression at the level of the pilosebaceous unit are the presence of androgen in the form of either testosterone or dihydrotestosterone; and functioning androgen receptors. A third component may be the metabolism of androgen precursors to active androgens within pilosebaceous units. Hormonal treatment of hyperandrogenism (acne, hirsutism, androgenetic alopecia) such as that seen in polycystic ovary syndrome, centers on reduction of circulating androgen levels and androgen receptor blockade. Combination oral contraceptives represent the primary treatment modality for reducing circulating androgens from ovarian and, to a lesser degree, adrenal sources. Newer formulations may also have clinically significant androgen receptor blocking and 5alpha-reductase inhibiting effects. Newer oral contraceptives have high safety profiles and are used widely internationally for this purpose. Androgen receptor blockers currently in use include spironolactone, cyproterone acetate, and flutamide. Androgen receptor blockers are frequently combined with oral contraceptives to achieve optimal results in selected women. In women with adrenal hyperplasia, low-dose corticosteroids may be added to reduce adrenal androgen precursors. Inhibition of enzymes of androgen metabolism in the pilosebaceous unit remain largely investigational in the treatment of acne, although the benefit of 5alpha-reductase (type 2) inhibition is established in androgenetic alopecia in men. This article reviews the essentials of hormonal influence in acne pathogenesis, discusses the hormonal therapies most utilized in the treatment of acne, and the pre-treatment evaluation of women in whom hormonal therapies are being considered.     

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。     

Evaluation of plasma testosterone: Which test and when?

Biochemical evaluation of androgenicity in men and women requires the determination of plasma testosterone (T). Because essentially only nonspecifically bound T appears to be available to tissues and to be bioactive (Bio-T), it may be required, in some instances, to determine the Bio-T fraction (free T [FT] and albumin-bound T). Surprisingly, a very important interlaboratory variation in T levels does exist and the lack of precision of current methods does not allow accurate measurement of T levels in women or prepubertal boys. Thus, each laboratory should establish its own range of normal values. As to parameters of FT or Bio-T, kits for direct measurement of FT are unreliable. Equilibrium dialysis, the gold standard of FT, is not suited for clinical routine, whereas the FT index (T/sex hormone-binding globulin [SHBG]) is a reliable parameter of FT in women only; calculation of FT and Bio-T (from T, SHBG, and albumin concentration) yields reliable results, but the absolute values depend on the association constants of SHBG and albumin for T used. In men (F)T is mainly used to confirm the clinical diagnosis of hypogonadism or to modulate androgen treatment. In otherwise healthy hypogonadal men, measurement of total T will suffice, but in patients with conditions affecting binding proteins (eg, thyroid or liver pathology, nephrotic syndrome, obesity) measurement of Bio-T may be required. In women, androgen measurement is generally required to evaluate androgen excess (eg, polycystic ovary syndrome, ovulatory dysfunction, hirsutism).     

Evaluation of plasma testosterone: Which test and when?

Biochemical evaluation of androgenicity in men and women requires the determination of plasma testosterone (T). Because essentially only nonspecifically bound T appears to be available to tissues and to be bioactive (Bio-T), it may be required, in some instances, to determine the Bio-T fraction (free T [FT] and albumin-bound T). Surprisingly, a very important interlaboratory variation in T levels does exist and the lack of precision of current methods does not allow accurate measurement of T levels in women or prepubertal boys. Thus, each laboratory should establish its own range of normal values. As to parameters of FT or Bio-T, kits for direct measurement of FT are unreliable. Equilibrium dialysis, the gold standard of FT, is not suited for clinical routine, whereas the FT index (T/sex hormone-binding globulin [SHBG]) is a reliable parameter of FT in women only; calculation of FT and Bio-T (from T, SHBG, and albumin concentration) yields reliable results, but the absolute values depend on the association constants of SHBG and albumin for T used. In men (F)T is mainly used to confirm the clinical diagnosis of hypogonadism or to modulate androgen treatment. In otherwise healthy hypogonadal men, measurement of total T will suffice, but in patients with conditions affecting binding proteins (eg, thyroid or liver pathology, nephrotic syndrome, obesity) measurement of Bio-T may be required. In women, androgen measurement is generally required to evaluate androgen excess (eg, polycystic ovary syndrome, ovulatory dysfunction, hirsutism).     

女性痤疮与多囊卵巢综合征的相关性研究

目的 检测成年女性痤疮患者体内性激素水平的变化,探讨其与多囊卵巢综合征（PCOS）的相关性。方法 采用放射免疫分析法,对50例痤疮患者进行血清性激素水平测定和妇科经阴道超声检查。以30例正常成年女性为对照。结果 痤疮组睾酮、二氢睾酮、脱氢表雄酮及黄体生成素水平增高,与正常对照组比较差异有高度显著性（P＜0．001或P＜0．01）;雌二醇、卵泡刺激素、孕酮水平变化不明显（P均＞0．05）。50例中有28例患PCOS。对其中10例应用达英－35治疗,可降低血清雄激素水平。结论 高雄激素血症和PCOS与成年女性痤疮有关,且是其长期不愈的重要原因。达英－35对此类痤疮有较好疗效。     

女性更年期痤疮患者的临床特征及睾酮和雌二醇水平的检测

目的 探讨女性更年期痤疮患者血清性激素水平的变化,临床特征及治疗方法。方法 对66例患者的临床特征及治疗进行了观察;测定其中35例患者的血清睾酮和雌二醇水平。结果 患者睾酮、雌二醇与正常人对照组相比较差异无显著性,但睾酮/雌二醇显著高于正常人对照组(P<0.05)。63.6%的患者在更年期发病。皮损以上唇及颏部最多,其次为颊部、额部,多呈散在分布,以粉刺及炎性丘疹或丘脓疱疹为主,少数有炎性结节。多为轻至中度痤疮。78.8%的患者一般治疗即可治愈,其余患者用性激素治愈。结论 更年期因卵巢功能衰退,雌激素分泌减少,雌雄激素比例失衡,肾上腺源性雄激素相对过甚而导致痤疮。更年期痤疮多为轻至中度,皮损以粉刺、炎性丘疹或丘脓疱疹为主,以上唇及颏部最多。绝大多数患者一般治疗即可治愈。     

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.