Age-dependent endocrine disorders involved in the pathogenesis of refractory acne in women

Abstract

Acne is a disorder of the pilosebaceous unit, common among adolescents, which may be extended to adulthood. The aim of this study was to assess the prevalence of hormonal disorders in women with acne resistance to conventional therapy. We included 72 women aged between 15 and 36 years (divided in two age groups) who presented to our clinic between May and October 2014, suffering from moderate and severe forms of papulopustular and nodulocystic acne. The subjects were non‑responsive to classic dermatological treatment or had clinical manifestation of hyperandrogenism. Based on age, we divided the women into two groups, group I with 40 patients aged 15‑22 years and group II with 32 patients aged 23-36 years. Using ELISA, a hormonal profile was performed for each patient in days 1‑3 of the menstrual cycle including, total testosterone, dehydroepiandrosterone sulfate (DHEA‑S), follicle‑stimulating hormone (FSH), luteinizing hormone (LH), estradiol, prolactin, and plasma cortisol. For statistical analysis we used Stata 13 software. We compared the hormonal profile of the two groups and identified significant differences for: testosterone levels (mean value, 0.64±0.35 vs. 0.97±0.50 ng/ml; p<0.0001), DHEA‑S levels (mean value, 0.85±0.27 vs. 1.05±0.33 mg/24 h; p=0.001), prolactin levels (mean value, 281.85±91.113 vs. 353.969±102.841 mIU/ml; p=0.002) and LH levels (14.8±6.7 vs. 20.1±8.2 mIU/ml; p=0.002) were higher in group Ⅱ. No statistically significant differences were found for estradiol (p=0.588) and cortisol (p=0.182) levels. In conclusion, refractory acne can be the first sign of systemic illness including polycystic ovary syndrome. Thus, for a correct therapeutic approach it is necessary to interpret the clinical and biochemical elements in correlation with the medical history.

Figure 1.

Hormonal disturbances in patients from group I (15–22 years) comparative with group II (23–36 years). We accounted testosterone high >0.9 ng/ml, DHEA-S high >1 mg/24 h, estradiol high >607 pmol/l (in follicular phase), LH high >25 mIU/ml, FSH low <15 mIU/ml, prolactin high >498 mIU/ml and cortisol high >230 ng/ml. DHEA-S, dehydroepiandrosterone-sulfate; LH, luteinizing hormone; FSH, follicle-stimulating hormone.

Figure 2.

Distribution of the hormone levels in the two groups. Single dot, low outlier value; double dot, high outlier value.

Figure 3.

The positive correlation of age with (A) testosterone and (B) DHEA-S levels. DHEA-S, dehydroepiandrosterone-sulfate.

Figure 3.

The positive correlation of age with (A) testosterone and (B) DHEA-S levels. DHEA-S, dehydroepiandrosterone-sulfate.