Hormonal Therapies For Acne

Abstract Acne is a common, worldwide problem that is usually multifactorial in etiology, but androgens may play a pivotal role in the development and severity of acne. Endocrinopathies, like polycystic ovarian syndrome, ovarian tumors, or adrenal hyperplasia or tumors may be detected in some patients with acne, especially if acne is sudden in onset, associated with hirsutism or menstrual irregularities, or associated with cushingoid facies, acanthosis nigricans, patterned hair loss, or deepened voice. In these instances, serum free and total testosterone, DHEAS, and LH, and FSH should be tested. Appropriate referral and long term follow up is warranted in patients diagnosed with an endocrinopathy. Hormonal therapies for acne include systemic medications with various mechanisms: androgen receptor blockers, adrenal androgen production blockers, or ovarian androgen production blockers. Androgen receptor blockers include spironolactone, cyproterone acetate, chlormadinone, and flutamide; adrenal androgen production blockers include glucocorticoids, and ovarian production blockers include gonadotropin-releasing agonists and oral contraceptives. Herein, practical guidelines are shared for the practicing physician treating hormonally related acne.