Objectives: To correlate acne severity with elevated androgen levels and to compare androgen levels between cases and controls. Methods: This case-control study was carried out in the Department of Dermatology, Mayo Hospital, Lahore from March 2016 – March 2017. Two hundred and seventy patients and eighty age and gender-matched controls were recruited after ethical approval and informed consent and categorized into mild, moderate and severe acne. Severity was correlated with serum Testosterone, Dihydrotestoststerone and Dihydroepiandrosterone Sulphate levels. Quantitative variables were expressed as median and percentiles, comparisons done by Mann-Whitney and correlations by Spearman correlation. P-value of <0.05 was considered statistically significant. Results: There were 142 (41%) males and 208 (59%) females. Ninety-Seven patients had mild, 108 moderate and 65 had severe disease. Median hormonal levels were 3.5ng/ml, 184pg/ml and 0.82ug/dl for Testosterone, Dihydrotestosterone and Dihydroepiandrosterone Sulphate respectively which differed significantly between cases and controls. There was no correlation with severity but the levels differed significantly between the different grades in case of Testosterone and DHEAS. Conclusion: Androgens are not directly correlated with acne severity, but affect acne severity as seen in difference between their levels in different grades of acne. Anti-androgens may be initiated early in acne resistant to conventional therapy. How to cite this:Iftikhar U, Choudhry N. Serum levels of androgens in acne & their role in acne severity. Pak J Med Sci. 2019;35(1):---------. doi: https://doi.org/10.12669/pjms.35.1.131 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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The management of urticaria, although complex, relies on two postulates: • Recognition and eradication of the triggering factor(s) • Provision of symptomatic relief Recognition and eradication of the triggering factors(s) Factors known are drugs, food, infections, and physical stimuli. Drugs: Analgesics and NSAIDs can exacerbate already present urticaria and are also recognized triggers of new-onset urticaria.2 When suspected, they should be withdrawn entirely or can be replaced. ACE inhibitors can cause angioedema. Eradication of infectious agents Infections and infestations should be treated where suspected, including infections of the GI tract e.g., H Pylori associated gastritis3, nasopharyngeal bacterial infections, and intestinal worms.8 Management of diet The allergens in food need to be avoided if a patient has type I hypersensitivity to any one of these allergens. Pseudo-allergic reactions5 which are not IgE mediated have been described for organic foods and food additives.9-13 Physical stimuli They are usually recognized and controlled, e.g., in chronic pressure urticaria patients are advised to use bags with a wide handle and similarly, in symptomatic dermographism, simple avoidance of friction can give relief from symptoms.15 Symptomatic therapy One of the objectives of symptomatic therapy is to mask the effects of histamine, platelet-activating factor, and other mast cell mediators. Histamine plays a primary role in inducing the symptoms associated with urticaria. The activation of receptors on endothelial cells by histamine results in wheals whereas this histamine receptor activation on sensory nerves results in itching. Different guidelines have been proposed for managing chronic urticaria including the EACCI [5] and BSACI [4].