A study comparing the clinical and hormonal profile of late onset and persistent acne in adult females

Abstract

Background Adult acne has been classified into two major subtypes: “persistent acne” and “late onset acne”. A surrogate marker of hyperandrogenism (HA) in adult female acne is the presence of clinical signs of HA and biochemical hyperandrogenemia. We compared the clinical and hormonal profiles of the two acne subtypes and evaluated the likely source of androgen excess – ovarian or adrenal. Methods Female acne patients 25 years of age and older were evaluated for clinical HA. Hormonal assessment included total testosterone (TT), sex hormone binding globulin (SHBG), free androgen index (FAI), anti‐Mullerian hormone (AMH), 17‐hydroxyprogesterone (17‐OHP), dehydroepiandrosterone sulfate (DHEAS), follicle stimulating hormone (FSH), luteinizing hormone (LH), thyroid stimulating hormone (TSH), and prolactin. DHEAS and 17‐OHP represented adrenal androgens and AMH indicated ovarian reserve. Results Of 120 cases, clinical HA was seen in 71.67% while biochemical hyperandrogenemia was detected in only 18.33% of patients. Though late onset was more common in adult acne patients (56.6%), the persistent acne subgroup (43.33%) had a younger age at onset, a past history of adolescent acne (51.92%), truncal predilection (44.23%), polycystic ovary syndrome (PCOS) (44.23%), significant presence of irregular menses (40.38%) and hirsutism (57.69%), and increased TT (13.46%), 17‐OHP (76.92%), AMH (44.23%), and increased LH/FSH (15.38%) ratio. PCOS was seen more in the persistent acne patients with clinical HA and increased 17‐OHP levels. Conclusion Persistent acne patients had marked clinical HA, PCOS, and hormonal abnormalities necessitating an endocrinological evaluation. As a corollary, this subgroup would benefit from antiandrogen therapy.

A prospective study of anti‐mullerian hormone and other ovarian and adrenal hormones in adult female acne

“…Here, it must be noted that the levels of hormones are not always raised above the reference range, as only five (16.13%) of our patients with PCOS had testosterone raised above the reference value, which concurs with previous studies. 6,19 Here, we may point out that only 18.3% of our patients had one of the three androgens elevated (TT, DHEAS and FAI) 41 which is at variance with other studies. 21,42,43 This is explained by the role of high level of the tissue derived end organ androgens like three alpha androstenediol glucuronide and androsteroneglucuronide in women with normal circulating hormones, which has been noted in acne.…”

Female Adult Acne and Androgen Excess: A Report From the Multidisciplinary Androgen Excess and PCOS Committee

“…The correlation between androgen excess and development of adult female acne is well documented [ 28-32 ]. Because in most instances androgen excess starts during puberty, persistent adult female acne (a form of adult acne beginning during adolescence and continuing until adulthood) is associated more with hyperandrogenism than adult female acne beginning in later life [ 33 ].…”

Clinical and epidemiological characteristics and hormonal profile of adult females with acne vulgaris: a cross-sectional study from a tertiary care hospital

“…However, biochemical hyperandrogenaemia was found only in 18.33% cases. 15 In another study, hyperandrogenism was reported in 17.9% females with acne. 12 In our study, the elevated testosterone was seen in 15.69% patients.…”

“…14 However, in another study involving only adult female patients, the difference between two types was not considerable (late onset acne 56% vs persistent acne 43%). 15 In females, acne lesions are more commonly seen on the lower part of the face, especially chin and jawline. 16 However, in many adult female patients this presentation may not be seen.…”