Hormone therapy in acne

Abstract

Underlying hormone imbalances may render acne unresponsive to conventional therapy. Relevant investigations followed by initiation of hormonal therapy in combination with regular anti-acne therapy may be necessary if signs of hyperandrogenism are present. In addition to other factors, androgen-stimulated sebum production plays an important role in the pathophysiology of acne in women. Sebum production is also regulated by other hormones, including estrogens, growth hormone, insulin, insulin-like growth factor-1, glucocorticoids, adrenocorticotropic hormone, and melanocortins. Hormonal therapy may also be beneficial in female acne patients with normal serum androgen levels. An understanding of the sebaceous gland and the hormonal influences in the pathogenesis of acne would be essential for optimizing hormonal therapy. Sebocytes form the sebaceous gland. Human sebocytes express a multitude of receptors, including receptors for peptide hormones, neurotransmitters and the receptors for steroid and thyroid hormones. Various hormones and mediators acting through the sebocyte receptors play a role in the orchestration of pathogenetic lesions of acne. Thus, the goal of hormonal treatment is a reduction in sebum production. This review shall focus on hormonal influences in the elicitation of acne via the sebocyte receptors, pathways of cutaneous androgen metabolism, various clinical scenarios and syndromes associated with acne, and the available therapeutic armamentarium of hormones and drugs having hormone-like actions in the treatment of acne.

Effectivity of Preovulation Phase Autologous Serum Application on Moderate-Severe Acne Vulgaris Patients

“…People who are not sensitive to androgens would not suffer from acne because they do not produce sebum; and a high androgen state will accompanied by acne. [15] While androgen role is very important, the process involved is quite complex. Variations in clinical response to androgens in some patients indicate that local factors and circulating factors other than the androgen also influence acne development.…”

“…The average prevalence in adolescent is estimated around 70 to 87%, which is characterized by comedones, papules, pustules, and nodules. [14,15] In acne pathogenesis, androgens have a very important role. Generally, acne vulgaris will not develop in the absence of androgen hormone.…”

Is hormonal treatment still an option in acne today?

“…Acne is not caused by a hormonal misfit, but hormones, primarily androgens and related receptors, can play a role in its pathophysiology and treatment . Before puberty, the adrenal glands produce increasing amounts of dehydroepiandrosterone sulphate (DHEAS), which can be metabolized into more potent androgens in the skin, driving enlargement of the sebaceous gland and increased sebum production; this is a prerequisite for acne in all populations.…”

The high homeostatic model assessment of insulin resistance as risk factor for acne vulgaris

“…This is shown in sebocytes SEB-1 and by sterol induction response elementbinding protein-1 (SREBP-1). 5 Insulin receptors are structurally as same as IGF-1 receptors and insulin can bind to IGF-1 receptors. At very high doses, insulin increases the expression of sebocyte growth hormone receptors.…”

“…At very high doses, insulin increases the expression of sebocyte growth hormone receptors. 5,6 In the skin, besides inducing lipid production in human sebocytes, keratinocyte proliferation in vivo and in vitro induced by IGF-1. In acne lesions compared to healthy skin, IGF-1 and IGF-1R were overexpressed.…”