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Year : 1990  |  Volume : 56  |  Issue : 6  |  Page : 427-429

Serum testosterone, DHEA-S and androstenedione levels in acne

Correspondence Address:
A Hatwal

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Basal serum levels of total testosterone, dehydroepiandosterone sulfate (DHEA, - S) and androstenedione (A4) were measured by radioimmunoassay in 100 patients of acne vulgaris, and in 100 age and sex matched acne free healthy subjects. In males with acne the mean serum testosterone levels were marginally and the DHEAS and A4A levels were significantly higher as compared to controls (p). Females with acne had significantly higher levels of testosterone (p<0.001), DHEA-S (p<0.001) and (p < 0.01) than controls. Our data suggest that increased adrenal androgen levels in plasma may be responsible for treatment resistant acne vulgarism

Keywords: Testosterone. Dehydroepiandrosterone-sulfate. Androstenedione. Acne vulgaris. Adrenal

How to cite this article:
Hatwal A, Singh S K, Agarwal J K, Singh G, Bajpai H S, Gupta S S. Serum testosterone, DHEA-S and androstenedione levels in acne. Indian J Dermatol Venereol Leprol 1990;56:427-9

How to cite this URL:
Hatwal A, Singh S K, Agarwal J K, Singh G, Bajpai H S, Gupta S S. Serum testosterone, DHEA-S and androstenedione levels in acne. Indian J Dermatol Venereol Leprol [serial online] 1990 [cited 2020 May 28];56:427-9. Available from: http://www.ijdvl.com/text.asp?1990/56/6/427/3593

Androgens have been implicated in the pathogenesis of acne vulgaris[1] but the exact manner in which they may be predisposing to acne is not uniformly agreed upon. The mechanisms suggested include : increased circulating levels of androgens[2], increased free androgen levels[3], increased local metabolism of androgens in skin[4] and increased tissue sensitivity to androgens[5]. As there is inadequate evidence on the status of circulating androgens in patients of acne, this study was undertaken to evaluate the same.

  Materials and Methods Top

A total of 100 patients (50 males and 50 females) of moderate to severe acne vulgaris resistant to conventional treatment were included in the study (age range : 14 to 25 years; peak age incidence : 20-22 years). None of the patients was receiving any systemic drug, oral contraceptives or hormonal therapy. 100 age and sex matched healthy acne free subjects were also part of the study.

Venous blood samples were collected for the assay of serum testosterone, dehydroepiandrosterone-sulfate (DHEA-S) and androstenedione (A4A) between 0800-0900 hours. For testosterone assay three samples were collected at 20 minute intervals and pooled together. Immediately after collection the red cells were separated and the sera were stored at - 20C till assay. In females, the samples were collected only in the first half of the follicular phase of the menstrual cycle. All hormones were measured by radioimmunoassay using standard techniques with commercially obtained kits. For testosterone and A4A the kits were obtained from RSL Laboratories, Denville, NJ (USA) and for DHEA-S from Biotec Inc. Minneapolis, Minnesota (USA). The inter and intra-assay coefficients of variation were: 4.2% and 6.0% for testosterone; 10.4% and 8.0% for D4A and 8.7% and 5.% for DHEA-S.

The results of serum measurements were compared by Student's t-test.

  Results Top

All patients included in the study had moderate to severe acne. The commonest lesions encountered were pustules and nodules while cysts were present in 20/50 males and 17/50 females. 64/100 patients had acne lesions also on the trunk. The mean duration of acne was 2.6 years (range 1 to 6 years). A history of partial or no response to conventional treatment was present in all the patients. Mild to moderate degree of hirsutism was present in 14/50 female patients; of whom 4 also had oligomenorrhea. No other sign of virilisation was observed in any female patient.

In males with acne the mean serum testosterone levels were only marginally elevated but their 44A and DHEA-S levels were significantly higher than in controls [Table - 1].

As shown in [Table - 2], the mean serum levels of all three androgens were significantly higher in females with acne than in their control counterparts:

  Comments Top

The status of basal serum androgens in patients of acne vulgaris remains controversial. Certain previous studies have reported raised serum testosterone and DHEA-S levels in females with acne[2],[6] while others have found only free testosterone to be raised.[7] Serum D4A levels have not, to our knowledge, been so far investigated in females with acne.

It has earlier been observed that serum testosterone levels in males with acne are similar to those in controls.[8],[9] We found only marginally higher levels of serum testosterone in our male patients. Marynick et a1[2] have reported elevated levels of serum DHEA-S in men with cystic acne but there are no available reports on serum A[4]A levels in males with acne.

Since DHEA-S almost wholly and A4A is partly secreted from the adrenal cortex and can be peripherally converted to testosterone and dihydrotestosterone[10], it is possible that there may be a state of adrenal hypersecretion in patients with recalcitrant acne. This may, however, not be severe enough to produce other features of hyperandrogenism. Acne lesions are known to aggravate with emotional stress, perhaps by way of an overactive pituitary adrenal axis.[11] These patients should be investigated to exclude adrenal enzyme defects as treatment with anti-androgens is likely to be rewarding in such type of patients.[12]

  References Top

1.Kligman AM: An overview of acne. J Invest Dermatol 1974; 62: 268-287.  Back to cited text no. 1    
2.Marynick SP, Chakmajian ZH, McCaffree DL, C Herndon JH: Androgen excess in cystic acne. N Engl J Med 1983; 308: 981-986.  Back to cited text no. 2    
3.Schiavone FE, Reitschel RL, Sgontas D, Harris R: Elevated free testosterone levels in women with acne. Arch Dermatol 1983; 119: 799-802.  Back to cited text no. 3    
4.Sansone G, Reisner RM: Differential rates of conversion of testosterone and dihydrotestosterone in acne and in normal skin : A possible pathogenic factor in acne. J Invest Dermatol 1972; 56: 366372.  Back to cited text no. 4    
5.Hay JB, Hodgins MB: Metabolism of androgens in human skin in acne. Brit J Dermatol 1974; 91: 123133.  Back to cited text no. 5    
6.Lucky AW, McGuire J, Rosenfeld RL, Lucky PA, Rich BH: Plasma androgens in women with acne vulgaris. J Invest Dermatol 1983; 81: 70-74.  Back to cited text no. 6    
7.Gilliland JM, Kirk J, Smeaton TC: Normalised androgen ratio : Its application to clinical dermatology. Clin Exp Dermatol 1981; 6: 349-353.  Back to cited text no. 7    
8.Forstrom L, Mustakallio KK, Dessypris A, Uggeldahl PE, Adlecrutz H: Plasma testosterone levels and acne. Acta Derm Venereol (Stockh) 1974; 54: 369371.  Back to cited text no. 8    
9.Lim JS, James VHT: Plasma androgens in acne vulgaris. Brit J Dermatol 1974; 91: 135-143.  Back to cited text no. 9    
10.Abraham GE: ovarian and adrenal contribution to peripheral androgens during the menstrual cycle. J Clin Endocrinol Metab 1974; 39 : 340-346.  Back to cited text no. 10    
11.Strauss JS: Sebaceous glands : in Dermatology in General Medicine. Ed Fitzpatrick TB, Eisen AZ, Wolff K, Freedberg IM and Austen KF Mc Grawhill, USA, 1979.  Back to cited text no. 11    
12.Hatwal A, Bhatt RP, Agrawal JK, Singh G, Bajpai HS: Spironolctone and cimetidine in treatment of acne. Acta Derm Venereol (Stockh) 1988;68:84-87.  Back to cited text no. 12    


[Table - 1], [Table - 2]


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