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

Carmina, Enrico; Dréno, Brigitte; Lucky, William; Agak, George W.; Dokras, Anuja; Kim, Jin Ju; Løbo, Rogerio A.; Tehrani, Fahimeh Ramezani; Dumesic, Daniel A.

doi:10.1210/jendso/bvac003

Cited by 25 publications

(9 citation statements)

References 126 publications

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“…Hirsutism was assessed by Ferriman–Gallwey–Lorenzo scores [ 13 ], and patients with scores higher than 6 were considered hirsute. Adult acne and female pattern hair loss were not considered a sign of hyperandrogenism if androgen levels were normal [ 14 , 15 ].…”

Section: Methodsmentioning

confidence: 99%

Increased Prevalence of Elevated DHEAS in PCOS Women with Non-Classic (B or C) Phenotypes: A Retrospective Analysis in Patients Aged 20 to 29 Years

Carmina

Longo

2022

Cells

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It is well known that a subgroup of women with PCOS present an excessive adrenal androgen production, generally associated with ovarian hyperandrogenism. In the past, it has been impossible to correlate adrenal hyperandrogenism to any clinical or hormonal pattern of PCOS. However, adrenal androgens are strictly dependent on age and their blood values reduce by 40% in patients moving from their twenties to thirties. Due to this, serum DHEAS values are strongly influenced by the age distribution of studied populations. To avoid this bias, in this study we retrospectively analyzed the clinical and hormonal data of PCOS women in their twenties (age between 20 and 29 years). Data of 648 young hyperandrogenic women with PCOS were evaluated. Serum DHEAS was increased in a third (33%) of studied patients and was associated with higher values of testosterone (T) and androstenedione (A). In each phenotype, patients with high DHEAS had higher values of T and A than patients with normal DHEAS of the same phenotype. Therefore, a DHEAS increase is generally part of a generalized higher androgen production in a subgroup of PCOS patients, independently of the finding of anovulatory or ovulatory cycles or of polycystic or normal ovaries. However, our study showed some important differences between PCOS phenotypes. A lower prevalence of increased DHEAS in A phenotype PCOS patients who generally have the highest androgen levels, versus non-classic (B or C) PCOS phenotypes, was observed. It was also found that patients with A phenotype PCOS present significantly lower BMI and serum insulin than patients with normal DHEAS of the same phenotype while, in patients with the B or C phenotype, the opposite occurs. We conclude that adrenal hyperandrogenism is more common in patients with non-classic (B and C) phenotypes of PCOS and is generally part of a generalized higher production of androgens in a subgroup of PCOS patients. However, other factors may increase the adrenal androgen production and influence the clinical expression of the syndrome. More studies in large, selected for age, populations of PCOS women with different phenotypes are needed.

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Section: Methodsmentioning

confidence: 99%

Increased Prevalence of Elevated DHEAS in PCOS Women with Non-Classic (B or C) Phenotypes: A Retrospective Analysis in Patients Aged 20 to 29 Years

Carmina

Longo

2022

Cells

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“…It is generally accepted that acne does not occur without sebum. Sebaceous gland activity increases during puberty in response to androgens ( 16 ). The anaerobic and lipophilic microenvironment of the PSU favors the growth of C. acnes over other skin microbes.…”

Section: Etiology and Pathogenesis Of Acnementioning

confidence: 99%

T Cell Extracellular Traps: Tipping the Balance Between Skin Health and Disease

et al. 2022

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The role of extracellular traps (ETs) in the innate immune response against pathogens is well established. ETs were first identified in neutrophils and have since been identified in several other immune cells. Although the mechanistic details are not yet fully understood, recent reports have described antigen-specific T cells producing T cell extracellular traps (TETs). Depending on their location within the cutaneous environment, TETs may be beneficial to the host by their ability to limit the spread of pathogens and provide protection against damage to body tissues, and promote early wound healing and degradation of inflammatory mediators, leading to the resolution of inflammatory responses within the skin. However, ETs have also been associated with worse disease outcomes. Here, we consider host-microbe ET interactions by highlighting how cutaneous T cell-derived ETs aid in orchestrating host immune responses against Cutibacterium acnes (C. acnes), a commensal skin bacterium that contributes to skin health, but is also associated with acne vulgaris and surgical infections following joint-replacement procedures. Insights on the role of the skin microbes in regulating T cell ET formation have broad implications not only in novel probiotic design for acne treatment, but also in the treatment for other chronic inflammatory skin disorders and autoimmune diseases.

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“…Поняття клінічної ГА включає наявність гірсутизму при оцінюванні за модифікованою шкалою Феррімена-Голлвея [4,5]. Aкне й андрогенетична алопеція (втрата волосся за жіночим типом (ВВЖТ)) також часто асоційовані з підвищеними рівнями циркулювальних андрогенів [6,7].…”

Section: вступunclassified

“…Згідно зі звітом Мультидисциплінарного комітету з гіперандрогенії та синдрому полікістозних яєчників (Multidisciplinary Androgen Excess and PCOS Committee) 2019 р. [6], термін «андрогенетична алопеція» було рекомендовано замінити на термін «втрата волосся за жіночим типом». Під ВВЖТ розуміють специфічний вид алопеції, при якому відбувається стоншення (мініатюризація) волосся передньої частини голови у жінок.…”

Section: патогенез та особливості диференційної діагностики клінічної гаunclassified

“…Результати нещодавно опублікованого дослідження показали, що у жінок репродуктивного віку з акне біохімічна ГА була виявлена в 72% випадків [42]. У звіті Мультидисциплінарного комітету з гіперандрогенії та синдрому полікістозних яєчників із питань акне і ГА в дорослих жінок (2022) зазначається незгода з рекомендаціями дерматологічних клінічних настанов щодо розгляду акне як переважно запального процесу і стверджується необхідність в оцінюванні андрогенного статусу в усіх жінок з акне [6]. Як і при гірсутизмі, при акне мають значення не лише рівні циркулювальних андрогенів, а й активність утворення ДГТ в межах сальних залоз під дією 5-α-редуктази [43,44].…”

Section: патогенез та особливості диференційної діагностики клінічної гаunclassified

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Practical approaches to the use of markers of biochemical hyperandrogenism in women

Тутченко

Бурка

Сидорова³

et al. 2022

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Hyperandrogenism (HA) remains an actual problem that raises a large number of questions, in particular, in cases of discrepancy between the clinical signs of HA and biochemical parameters. This review includes an analysis of recent studies of androgen synthesis and metabolism in healthy women of reproductive age; management of pathologies accompanied by HA; as well as contemporary approaches to the principles of prescribing and evaluating the results of the main available markers of biochemical HA. There are сoncepts of clinical and biochemical HA. Biochemical HA is an increase in the levels of various circulating androgens. The concept of clinical HA includes hirsutism as assessed by the modified Ferriman–Gallwey scale. The most common causes of HA include polycystic ovary syndrome, non-classical forms of congenital adrenal hyperplasia, other endocrine disorders. It is necessary to carry out a differential diagnosis of these conditions with more rare causes as a primarily tumor pathology. The choice and evaluation of laboratory markers of biochemical HA should be made taking into account clinical data such as puberty history, anovulation, polycystic ovarian morphotype, obesity; presence and degree of hirsutism and/or other androgen-associated dermatopathies, the characteristics of the course of clinical HA (sudden onset, rapid progression), presence of other endocrinopathies, liver and kidney dysfunction; diabetes mellitus. The objectives of the laboratory assessment of HA are determination of HA severity; determination of the source of excess androgen synthesis (ovaries, adrenal glands); assessment of the free fraction of circulating active androgens; in some cases, assessment of the formation of active androgens in the skin. The following indicators are used to solve the tasks in laboratory diagnostics: total testosterone, free testosterone, free androgen index, androstenedione, dehydroepiandrosterone sulfate, 17-hydroxyprogesterone, dihydrotestosterone. A comprehensive assessment of these indicators allows not only assessing the presence of HA and its severity, but also the nature of its leading and secondary components, which determine the presence and prognosis of metabolic risks and allow individualizing therapeutic approaches.

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

Cited by 25 publications

References 126 publications

Increased Prevalence of Elevated DHEAS in PCOS Women with Non-Classic (B or C) Phenotypes: A Retrospective Analysis in Patients Aged 20 to 29 Years

Increased Prevalence of Elevated DHEAS in PCOS Women with Non-Classic (B or C) Phenotypes: A Retrospective Analysis in Patients Aged 20 to 29 Years

T Cell Extracellular Traps: Tipping the Balance Between Skin Health and Disease

Practical approaches to the use of markers of biochemical hyperandrogenism in women

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