Treatment with a gonadotropin-releasing hormone agonist in acne or idiopathic hirsutism

Abstract

Six women with acne and six women with hirsutism were treated with the GnRH analog [D-Ser(Bu(t))6] LHRH-(1-9)ethylamide (Buserelin) for 6 months (nasal spray, 1,200 micrograms/day) to suppress ovarian steroidogenesis. All women were eumenorrheic and did not demonstrate any adrenal or ovarian dysfunction. During treatment, ovarian steroids, LH and FSH decreased, while DHEA-S showed minor modifications; the clinical score for both acne and hirsutism showed a significant reduction. Moreover, acne and hirsutism were still well controlled 6 months after therapy. Gonadal function resumed in all patients after discontinuation of therapy. Three patients suffered from hot flashes from the 4th month. These data demonstrate that suppression of ovarian steroid secretion might be an efficient treatment in women suffering from acne or idiopathic hirsutism, indicating that ovarian steroids may have a key-role in the pathogenesis of these conditions.

Treatment guidelines in adult women

“…GnRH agonists include agents such as nafarelin, leuprolide, and buserelin, which are only available as nasal sprays or injectables (15). Thus far, only one study has demonstrated efficacy of GnRH agonists in the treatment of acne (49). In six women with acne and six women with hirsutism, treatment with Buserelin nasal spray for six months led to a decrease in ovarian steroids, LH and FSH, and acne and hirsutism.…”

Hirsutism, Acne, and Hair Loss: Management of Hyperandrogenic Cutaneous Manifestations of Polycystic Ovary Syndrome

“…Injectable and nasal spray forms can be given and have been determined to have a reducing effect on acne, with or without endocrine abnormality (69). Treatment with GnRH agonists is associated with menstrual symptoms, headache, and bone loss.…”

Profiling and hormonal therapy for acne in women

“…[54] Pregnancy, lactation, and abnormal vaginal bleeding are the contraindications for GnRH therapy. [53] Suppressor of adrenal androgen secretionGlucocorticoids: Glucocorticoids in low doses can suppress the adrenal production of androgens. They are indicated in patients who have an elevated level of DHEAS associated with an 11- or 21-hydroxylase deficiency.…”

“…[54] Pregnancy, lactation, and abnormal vaginal bleeding are the contraindications for GnRH therapy. [53] …”

“…[53] They are available as nasal sprays (to be given 2-3 times a day), e.g., Nafarelin and Buserelin, subcutaneous injections (once daily), e.g., Buserelin and Leuprolide, intramuscular depot injection (to be given monthly), e.g., Triptroelin, and monthly subcutaneous implant (to be given monthly), e.g., Leuprolin, Goserelin. Though GnRH analogs are very effective in suppressing ovarian androgen secretion, there are no published studies using GnRH analogs for acne alone and their use is limited by their high cost and menopausal symptoms including bone loss on their long-term use.…”