Hyperandrogenemia in patients presenting with acne

Objective: To determine whether acne is associated with hyperandrogenemia, regardless of age of presentation. Design: Prospective controlled study. Setting: Tertiary-care medical center. Patient(s): Thirty consecutive unselected women presenting with acne and no hirsutism and 24 eumenorrheic healthy controls. Intervention(s): Serum samples was taken in all patients, and an acute 60-minute ACTH-(1–24) test was performed in 19 patients. Main Outcome Measure(s): Total and free T, sex hormone–binding globulin (SHBG), and DHEAS levels in basal samples, and ACTH-stimulated 17-hydroxyprogesterone (17-HP) response to exclude 21-hydroxylase (21-OH)–deficient nonclassic adrenal hyperplasia (NCAH) were determined. Result(s): Nonhirsute patients with acne demonstrated significantly lower levels of SHBG and higher free-T and DHEAS levels than controls. Nineteen (63%) acneic patients had at least one androgen value above the 95% of controls. In patients aged 12–18 years, 7/8 (88%) had at least one increased androgen value, compared with 12/22 (55%) patients aged 19–43 years. One patient (5.3%) was found to have 21-OH–deficient NCAH. Conclusion(s): Hyperandrogenemia was evident in a majority of nonhirsute acneic patients studied, regardless of age. These data suggest that androgen suppression may be useful in treating acne in many of these patients.