Hormonal Therapy for Acne

Acne affects more than 40 million people, of which more than half are women older than 25
years of age. These women frequently fail traditional therapy and have high relapse rates
even after isotretinoin. Recent advances in research have helped to delineate the important
role hormones play in the pathogenesis of acne. Androgens such as dihydrotestosterone
and testosterone, the adrenal precursor dehydroepiandrosterone sulfate, estrogens,
growth hormone, and insulin-like growth factors may all contribute to the development of
acne. Hormonal therapy remains an important part of the arsenal of acne treatments
available to the clinician. Women dealing with acne, even those without increased serum
androgens, may benefit from hormonal treatments. The mainstays of hormonal therapy
include oral contraceptives and antiandrogens such as spironolactone, cyproterone acetate,
or flutamide. In this article, we discuss the effects of hormones on the pathogenesis
of acne, evaluation of women with suspected endocrine abnormalities, and the myriad of
treatment options available.
Semin Cutan Med Surg 27:188-196 © 2008 Elsevier Inc. All rights reserved.

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