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.     

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.     

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.     

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.     

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.     

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.     

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.     

痤疮患者血清性激素水平的研究

采用放射免疫法测定了33例痤疮患者血清黄体生成素（LH）、卵泡刺激素（FSH）、雌二醇（E2）、睾酮（T）、孕酮（P）水平。发现女性患者LH、FSH、E2皆低于正常组（P＜0．001），T与正常组差异不显著（P＞0．05），P高于正常组（P＜0．01）。男性患者LH、FSH低于正常组（P＜0．001），E2和T较正常组差异不显著（P＞0．05）。提示血清LH、FSH水平的异常可能在痤疮发病中起一定作用。     

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.     

Oral spironolactone therapy in male patients with rosacea.

Spironolactone at 50 mg/day was orally administered for four weeks to 13 male patients with rosacea in order to observe its clinical effectiveness. Serum estradiol (E2), 17OH-progesterone (17OH-P4), testosterone (T), androstenedione (delta 4 A), dihydrotestosterone (DHT), dehydro-epiandrosterone sulfate (DHEA-S) were measured prior to and after treatment. Although there were no significant changes in T, delta 4A, DHT, or DHEA-S, the serum levels of 17OH-P4 increased significantly. E2 tended to increase, although the change was not significant. Two of the 13 patients discontinued spironolactone treatment because of general malaise, but seven of the remaining eleven patients exhibited an improvement in their rosacea. These findings demonstrate that a low dose of spironolactone is effective in the treatment of rosacea in some male patients and suggest that it is possible that changes in the metabolism of sex steroid hormones such as cytochrome p-450 isozymes have some bearing on the etiology of rosacea.     

Acne is not associated with abnormal plasma androgens

Plasma dehydroepiandrosterone sulphate, androstenedione, testosterone (T), dihydrotestosterone (DHT), and sex hormone binding globulin (SHBG) have been measured in 64 females and 26 males aged less than 25 years and with acne vulgaris. Oestradiol was measured in the males. Free T and free DHT were calculated. Acne was graded on three sites and the sebum excretion rate (SER) was measured in most patients. With the possible exception of free DHT, none of the plasma steroids or SHBG correlated with acne severity or with SER. Free DHT in the females showed a possible, but weak, correlation with total acne (r = 0.25, P = 0.07), but comparison with male data showed that this was not causative. The role of androgens in acne is permissive and plasma androgen measurements usually have no place in its management.     

女性痤疮患者卵泡期血清六项性激素水平的测定

目的探讨女性寻常痤疮患者体内性激素水平的改变。方法采用电化学发光免疫分析法对30例青春期女性痤疮患者及20例迟发性女性痤疮患者卵泡期血清六项性激素水平进行检测,并分别与相应年龄段的正常女性各15人作对照。结果女性青春期痤疮患者血清雌二醇水平明显低于同龄正常对照组(P<0.05);睾酮/雌二醇比值明显高于正常对照组(P<0.01);促卵泡素明显高于正常对照组(P<0.05);女性迟发性痤疮患者血清睾酮水平较相应年龄的正常对照组显著升高(P<0.05)。结论青春期女性痤疮发病的主要原因可能是由于雌激素分泌不足,使血清内睾酮水平相对增多所致。女性迟发性痤疮发病的主要原因则可能与雄激素分泌增多有关。     

66例痤疮患者血清睾酮及雌二醇水平研究

对６６例痤疮患者和２０名正常人的血清睾酮及雌二醇水平进行检测。结果显示：伴有多毛现象女性患者的血清睾酮水平和男性患者的雌二醇水平明显高于正常对照组（Ｐ〈０．０５），提示痤疮发生与性激素水平改变有关。     

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.     

座疮患者血清睾酮及雌二醇水平研究

我们测定了45例痊疮患者及38例正常人血清睾酮及雌二醇水平男性患者组血清雌二醇水平(230.2pmol/L)高于正常对照组(163.9 mol/L).女性患者组血清睾酮水平(5.45nmo1/L)高于正常对照组(3.71nmol/L).我们观察到18例女性患者中16例((88.9%)伴有程度不同的月经周期紊乱,故建议这种情况的痤疮患者可采用人工周期疗法.     

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.     

清热养阴、理气活血法治疗女性迟发性与持久性痤疮的临床与实验室研究

目的中医清热养阴、理气活血法治疗不同证型女性迟发性与持久性痤疮的临床与实验研究,并探讨其对痤疮患者神经生长因子、性激素与相关细胞因子水平的影响.方法随机分为治疗组与治疗对照组,38例治疗组给予中药芩参粉刺清口服液治疗,26例治疗对照组给予中药丹参酮胶囊治疗,并对其疗效进行了评价,同时运用放射免疫双抗法及双抗夹心ABC-ELISA法对治疗组、治疗对照组患者与30名正常对照者的血清睾酮(T)、雌二醇(E2)、神经生长因子(NGF)及白介素18(IL-18)水平进行检测并进行比较.结果两组患者皮损改善,但总有效率无统计学意义(P＞0.05).在三种不同证型的女性迟发性与持久性痤疮患者中,其血清NGF、T及IL-18水平明显高于正常对照组(P＜0.05).结论不同证型女性迟发性与持久性痤疮的发生与神经生长因子、性激素与细胞因子IL-18水平的影响有关.中医清热养阴、理气活血法是治疗女性迟发性与持久性痤疮的有效法则,它的治疗作用可能是通过调节患者血清神经生长因子、性激素与细胞因子IL-18水平实现的.     

青春期后女性痤疮患者血清性激素水平的研究

目的：检测青春期后女性痤疮患者体内性激素的水平。方法：采用放射免疫法对25岁以上的34例女性痤疮患者血清睾酮（T）、雌二醇（E2）、泌尿素（PRL）、黄体生成素（LH）和卵泡刺激素（FSH）进行了测定,并以32例正常女性作为对照。结果：患者组T显著高于对照组（P＜0．001）;E2和LH显著低于对照组（P＜0．001）;PRL和FSH无明显变化（P＞0．05）。结论：性激素异常可能是女性痤疮迟发和持久不退的主要原因。     

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。     

Testosterone concentrations and oligomenorrhea in women with acne

Background Androgen excess is frequently associated with oligomenorrhea as well as acne. Oligomenorrhea in hirsute women has been demonstrated to be associated with higher active testosterone levels than found in eumenorrheic hirsute women. This study was designed to evaluate whether similar findings are present in women with acne. Forty-four consecutive women with acne were evaluated by measuring their levels of total testosterone, biologically active testosterone, and free testosterone. The women with oligomenorrhea and acne had significantly higher levels of biologically active testosterone than those with eumenorrhea and acne. This implies that biological active testosterone should be measured in oligomenorrheic women with acne and, if elevated, consideration should be given to antiandrogen therapy. Methods Data were collected from 44 consecutive Caucasian women aged 14 to 38 years. The patients were separated into two groups based on menstrual history. Group 1 had regular menses, and group 2 had oligomenorrhea, defined as menstrual intervals of greater than 36 days. All patients had blood samples drawn on their initial office visit, regardless of the phase of the menstrual cycle, and the levels of total testosterone (TT), biologically active testosterone (BT), and free testosterone (FT) were obtained. Results The serum TT level was 87±41.3 ng/dL (range, 31–150 ng/dL) in oligomenorrheic women and 56±27.5 ng/dL (range 8–107 ng/dL) in eumenorrheic women. There was no statistically significant difference. The serum BT level in oligomenorrheic women was 33±16.9 ng/dL (range, 11–51 ng/dL) and In eumenorrheic women 19±13.6 ng/dL (range, 11–51 ng/dL). This difference was statistically significant (p <0.05). The serum FT level in oligomenorrheic women was 18±9.4 pg/mL (range, 1–29 pg/mL) and in eumenorrheic women 10±7.1 pg/mL (range, 1–32 pg/mL). This difference was not statistically significant (Table 1). Conclusions Women with acne and oligomenorrhea, similar to women with hirsutism and oligomenorrhea, have higher levels of biologically active testosterone than those with normal menses.