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Kutlu Ö, Karadağ AS, Wollina U. Adult acne versus adolescent acne: a narrative review with a focus on epidemiology to treatment. An Bras Dermatol 2023; 98:75-83. [PMID: 36253244 PMCID: PMC9837660 DOI: 10.1016/j.abd.2022.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/02/2022] [Accepted: 01/17/2022] [Indexed: 01/21/2023] Open
Abstract
Acne vulgaris is one of the most common chronic inflammatory diseases and is characterized by papules, pustules, comedones, and nodules. Although adolescence is the preferential age group, acne may affect various age groups. Acne shares different properties in adults and adolescents. These differences extend from epidemiology to treatments. Increased awareness of these two subtypes will allow for better management of the disease. In this review, the authors examined all aspects of acne in adults and adolescents under the light of current literature.
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Affiliation(s)
- Ömer Kutlu
- Department of Dermatology and Venereology, School of Medicine, Tokat Gaziosmanpasa University, Tokat, Turkey,Corresponding author.
| | - Ayşe Serap Karadağ
- Department of Dermatology and Venereology, Memorial Ataşehir Hospital, İstanbul, Turkey
| | - Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden, Dresden, Germany
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Poinas A, Lemoigne M, Le Naour S, Nguyen JM, Schirr-Bonnans S, Riche VP, Vrignaud F, Machet L, Claudel JP, Leccia MT, Hainaut E, Beneton N, Dert C, Boisrobert A, Flet L, Chiffoleau A, Corvec S, Khammari A, Dréno B. FASCE, the benefit of spironolactone for treating acne in women: study protocol for a randomized double-blind trial. Trials 2020; 21:571. [PMID: 32586344 PMCID: PMC7318446 DOI: 10.1186/s13063-020-04432-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/19/2020] [Indexed: 12/19/2022] Open
Abstract
Background Acne vulgaris has increased in women over the past 10 years; it currently affects 20–30% of women. The physiopathology of adult female acne is distinguished from that of teenagers essentially by two factors: hormonal and inflammatory. On a therapeutic plan, the four types of systemic treatment approved for female acne include cyclines (leading to bacterial resistance); zinc salts (less effective than cyclines); and antiandrogens (risks of phlebitis). The last alternative is represented by isotretinoin, but its use in women of childbearing potential is discouraged because of the teratogen risks. In this context, spironolactone could represent an interesting alternative. It blocks the 5-alpha-reductase receptors at the sebaceous gland and inhibits luteinizing hormone (LH) production at the pituitary level. It has no isotretinoin constraints and does not lead to bacterial resistance. Currently, very few studies have been performed in a limited number of patients: the studies showed that at low doses (lower than 200 mg/day), spironolactone can be effective against acne. In that context, it is clearly of interest to perform the first double-blind randomized study of spironolactone versus cyclines, which remains the moderate acne reference treatment, and to demonstrate the superiority of spironolactone’s efficacy in order to establish it as an alternative to cyclines. Methods Two hundred female patients will be included. They must have acne vulgaris with at least 10 inflammatory lesions and no more than 3 nodules. After randomization, the patients will be treated by spironolactone or doxycycline for 3 months and after placebo. The study will be blind for the first 6 months and open for the last 6 months. Discussion The treatment frequently used in female acne is systemic antibiotics with many courses, as it is a chronic inflammatory disease. In the context of the recent World Health Organisation (WHO) revelation about the serious, worldwide threat to public health of antibiotic resistance, this trial could give the physician another alternative in the treatment of adult female acne instead of using isotretinoin, which is more complex to manage. Trial registration ClinicalTrials.gov: NCT03334682. Registered on 7 November 2017.
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Affiliation(s)
- Alexandra Poinas
- Clinical Investigation Centre CIC1413, CHU Nantes and INSERM, Nantes, France.
| | - Marie Lemoigne
- Dermatology Department, CHU Nantes, Nantes University, CRCINA, Nantes, France
| | - Sarah Le Naour
- Dermatology Department, CHU Nantes, Nantes University, CRCINA, Nantes, France
| | - Jean-Michel Nguyen
- Department of Epidemiology and Biostatistics, CHU Nantes, Nantes, France
| | - Solène Schirr-Bonnans
- Service Evaluation Economique et Développement des Produits de Santé, Département Partenariats et Innovation, Centre Hospitalier Universitaire de Nantes, Nantes University, Nantes, France
| | - Valery-Pierre Riche
- Service Evaluation Economique et Développement des Produits de Santé, Département Partenariats et Innovation, Centre Hospitalier Universitaire de Nantes, Nantes University, Nantes, France
| | - Florence Vrignaud
- Clinical Investigation Centre CIC1413, CHU Nantes and INSERM, Nantes, France
| | - Laurent Machet
- Department of Dermatology, CHU Tours, INSERM U1253, University of Tours, Tours, France
| | | | - Marie-Thérèse Leccia
- Department of Dermatology, Allergology and Photobiology, CHU A. Michallon, Grenoble, France
| | - Ewa Hainaut
- Service de Dermatologie, Poitiers University Hospital, Poitiers, France
| | | | - Cécile Dert
- Service Evaluation Economique et Développement des Produits de Santé, Département Partenariats et Innovation, Centre Hospitalier Universitaire de Nantes, Nantes University, Nantes, France
| | - Aurélie Boisrobert
- Clinical Investigation Centre CIC1413, CHU Nantes and INSERM, Nantes, France.,Dermatology Department, CHU Nantes, Nantes University, CRCINA, Nantes, France
| | - Laurent Flet
- Department of Pharmacy, CHU Nantes, Nantes, France
| | - Anne Chiffoleau
- Direction de la Recherche, Département Promotion, Cellule Vigilances, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Stéphane Corvec
- CHU Nantes, Service de Bactériologie-Hygiène Hospitalière, CRCINA, INSERM, U1232, Université de Nantes, Nantes, France
| | - Amir Khammari
- Clinical Investigation Centre CIC1413, CHU Nantes and INSERM, Nantes, France.,Dermatology Department, CHU Nantes, Nantes University, CRCINA, Nantes, France
| | - Brigitte Dréno
- Clinical Investigation Centre CIC1413, CHU Nantes and INSERM, Nantes, France.,Dermatology Department, CHU Nantes, Nantes University, CRCINA, Nantes, France
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Sardana K, Bansal P, Sharma LK, Garga UC, Vats G. A study comparing the clinical and hormonal profile of late onset and persistent acne in adult females. Int J Dermatol 2020; 59:428-433. [DOI: 10.1111/ijd.14748] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/07/2019] [Accepted: 11/22/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Kabir Sardana
- Department of Dermatology Dr Ram Manohar Lohia Hospital & Post Graduate Institute of Medical Education and Research New Delhi India
| | - Prekshi Bansal
- Department of Dermatology Dr Ram Manohar Lohia Hospital & Post Graduate Institute of Medical Education and Research New Delhi India
| | - Lokesh K. Sharma
- Department of Biochemistry Dr Ram Manohar Lohia Hospital & Post Graduate Institute of Medical Education and Research New Delhi India
| | - Umesh C. Garga
- Department of Radiodiagnosis Dr Ram Manohar Lohia Hospital & Post Graduate Institute of Medical Education and Research New Delhi India
| | - Gauri Vats
- Department of Dermatology Dr Ram Manohar Lohia Hospital & Post Graduate Institute of Medical Education and Research New Delhi India
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Clayton R, Göbel K, Niessen C, Paus R, Steensel M, Lim X. Homeostasis of the sebaceous gland and mechanisms of acne pathogenesis. Br J Dermatol 2019; 181:677-690. [DOI: 10.1111/bjd.17981] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2019] [Indexed: 12/13/2022]
Affiliation(s)
- R.W. Clayton
- Skin Research Institute of Singapore Agency for Science, Technology and Research (A*STAR) Singapore
- Centre for Dermatology Research University of Manchester, and NIHR Manchester Biomedical Research Centre Manchester U.K
| | - K. Göbel
- Skin Research Institute of Singapore Agency for Science, Technology and Research (A*STAR) Singapore
- Department of Dermatology Cologne Excellence Cluster on Stress Responses in Aging Associated Diseases (CECAD), and Centre for Molecular Medicine Cologne The University of Cologne Germany
| | - C.M. Niessen
- Department of Dermatology Cologne Excellence Cluster on Stress Responses in Aging Associated Diseases (CECAD), and Centre for Molecular Medicine Cologne The University of Cologne Germany
| | - R. Paus
- Centre for Dermatology Research University of Manchester, and NIHR Manchester Biomedical Research Centre Manchester U.K
- Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami FL U.S.A
| | - M.A.M. Steensel
- Skin Research Institute of Singapore Agency for Science, Technology and Research (A*STAR) Singapore
- Lee Kong Chian School of Medicine Nanyang Technological University Singapore
| | - X. Lim
- Skin Research Institute of Singapore Agency for Science, Technology and Research (A*STAR) Singapore
- Lee Kong Chian School of Medicine Nanyang Technological University Singapore
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Sex differences in the risk factors for Staphylococcus aureus throat carriage. Am J Infect Control 2017; 45:29-33. [PMID: 27671360 DOI: 10.1016/j.ajic.2016.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/24/2016] [Accepted: 07/25/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Male gender and adiposity are considered to be risk factors for Staphylococcus aureus carriage. We tested whether colonization is related to free testosterone (fT) level and adiposity, measured with body mass index (BMI) and body fat percentage (BFP), in healthy adults. METHODS Blood sample and throat swabs were taken twice (at 4-week intervals) from healthy men and women aged 18-36 years. fT level, height, weight, and BFP were measured. Participants were classified as persistent carriers, intermittent carriers (excluded from the analyses), and noncarriers. The final sample was 152 participants: 85 men and 67 women. RESULTS BFP, but not BMI, correlated positively with S aureus colonization (P = .02) in men. BMI became a significant predictor of carriage only when comparing groups within and above norms (P = .04). There was no relationship for BMI nor BFP in women. Higher fT level was related to persistent carriage (P = .02) in women, there was no relationship for fT level in men. CONCLUSION Risk factors for S aureus carriage are sex dependent. Within-sex variation in colonization is related to fT level in women, whereas in men it is related to the amount of body fat.
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Affiliation(s)
- Danielle Marcoux
- Division of Dermatology, Hôpital Sainte-Justine, and University of Montreal, Montreal, Quebec
| | - Diane Thiboutot
- Division of Dermatology, The Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
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Sardana K, Singh C, Narang I, Bansal S, Garg VK. The role of antimullerian hormone in the hormonal workup of women with persistent acne. J Cosmet Dermatol 2016; 15:343-349. [PMID: 27320497 DOI: 10.1111/jocd.12235] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Kabir Sardana
- Dermatology; Maulana Azad Medical College; Delhi India
| | - Chanchal Singh
- Department of Obstetrics and Gynecology; Indraprastha Apollo Hospital; Delhi India
| | - Isha Narang
- Dermatology; Maulana Azad Medical College; Delhi India
| | | | - Vijay K Garg
- Dermatology; Maulana Azad Medical College; Delhi India
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Cinar N, Cetinozman F, Aksoy DY, Elcin G, Yildiz BO. Comparison of adrenocortical steroidogenesis in women with post-adolescent severe acne and polycystic ovary syndrome. J Eur Acad Dermatol Venereol 2014; 29:875-80. [PMID: 25176476 DOI: 10.1111/jdv.12696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 07/17/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Increased adrenocortical production appears to be associated with acne and hirsutism in acne and polycystic ovary syndrome (PCOS). However, the aetiological role of androgens in the pathogenesis of acne per se is far from being clear. OBJECTIVE We aimed to evaluate adrenocortical function in women with post-adolescent severe acne in comparison with patients with PCOS and healthy women. METHODS The study included 32 women with post-adolescent severe acne, 32 women with PCOS and 32 age and body mass index (BMI)-matched healthy controls (age 17-34 years, BMI: 20.8 ± 1.9 kg/m²). Women with acne did not have hirsutism or ovulatory dysfunction whereas all PCOS patients had androgen excess and ovulatory dysfunction. Measurements included basal testosterone (T), sex hormone-binding globulin (SHBG) and dehydroepiandrosterone sulphate (DHEAS) levels and serum 17-hydroxyprogesterone (17-OHP), androstenedione (A4), DHEA and cortisol levels in response to corticotropin (ACTH) stimulation. RESULTS T, free androgen index, DHEAS levels, basal and AUC (area under the curve) values for A4 were significantly higher in PCOS than women with acne and controls (P < 0.05 for all), whereas three groups did not differ for basal or AUC values of DHEA and cortisol. Women with PCOS and those with severe acne had significantly and similarly higher AUC values of 17-OHP compared to controls (P < 0.05). CONCLUSION Women with isolated post-adolescent severe acne do not have increased levels of adrenal androgens basally or in response to ACTH. However, these women have similar secretion pattern of 17-OHP with PCOS patients suggesting increased enzymatic activity in this pathway.
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Affiliation(s)
- N Cinar
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Hacettepe University School of Medicine, Hacettepe, Ankara, 06100, Turkey
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Çetinözman F, Yazgan Aksoy D, Elçin G, Yıldız BO. Insulin sensitivity, androgens and isotretinoin therapy in women with severe acne. J DERMATOL TREAT 2013; 25:119-22. [DOI: 10.3109/09546634.2012.751482] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Duygu Yazgan Aksoy
- Department of Internal Medicine, Endocrinology and Metabolism Unit, Hacettepe University School of Medicine,
Ankara, Turkey
| | - Gonca Elçin
- Department of Dermatology and Venereal Diseases,
Ankara, Turkey
| | - Bulent O. Yıldız
- Department of Internal Medicine, Endocrinology and Metabolism Unit, Hacettepe University School of Medicine,
Ankara, Turkey
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Trakakis E, Papadavid E, Dalamaga M, Koumaki D, Stavrianeas N, Rigopoulos D, Creatsas G, Kassanos D. Prevalence of non classical congenital adrenal hyperplasia due to 21-hydroxylase deficiency in Greek women with acne: a hospital-based cross-sectional study. J Eur Acad Dermatol Venereol 2012; 27:1448-51. [DOI: 10.1111/j.1468-3083.2012.04613.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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Meier L, Stange R, Michalsen A, Uehleke B. Clay jojoba oil facial mask for lesioned skin and mild acne--results of a prospective, observational pilot study. ACTA ACUST UNITED AC 2012; 19:75-9. [PMID: 22585103 DOI: 10.1159/000338076] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND External application of clay facial masks is a cosmetic procedure generally used to reduce skin lesions and to improve overall skin condition. OBJECTIVE Collecting pilot data about self-treatment with clay jojoba oil masks on participants with acne-prone, lesioned skin and acne. METHODS Open, prospective, observational pilot study: Participants received written information, instructions, and questionnaires without direct contact with the study physician. For 6 weeks, they applied the masks 2-3 times per week. The primary outcome is the difference of skin lesions: baseline vs. after 6 weeks. RESULTS 194 participants (192 female, 2 male, mean age (± SE) (32.3 ± 0.7 years) returned questionnaires and diaries. 133 of these participants returned complete and precise lesion counts (per-protocol (PP) collective). A 54% mean reduction in total lesion count was observed after 6 weeks of treatment with clay facial mask. Both inflammatory and non-inflammatory skin lesions were reduced significantly after treatment compared to baseline: Median counts (MC) of pustules per affected participant were reduced from 7.0 ± 0.9 to 3.0 ± 0.5 (mean individual reduction (MIR) = 49.4%), the MC of the papules from 3.5 ± 2.2 to 1.0 ± 0.4 (MIR = 57.3%), the MC of cysts from 2.0 ± 0.8 to 0.5 ± 0.4 (MIR = 68.6%) and the MC of comedones from 26.5 ± 6.3 to 16.0 ± 4.0 (MIR = 39.1%). DLQI-average score decreased from 5.0 ± 4.5 (mean ± SE) before to 2.1 ± 2.8 after treatment. CONCLUSIONS The present study gives preliminary evidence that healing clay jojoba oil facial masks can be effective treatment for lesioned skin and mild acne vulgaris.
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Affiliation(s)
- Larissa Meier
- Immanuel Hospital, Department of Complementary and Integrative Medicine, Charité University Medical Centre, Institute for Social Medicine, Epidemiology and Health Economics, Berlin, Germany
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Choi CW, Lee DH, Kim HS, Kim BY, Park KC, Youn SW. The clinical features of late onset acne compared with early onset acne in women. J Eur Acad Dermatol Venereol 2011; 25:454-61. [DOI: 10.1111/j.1468-3083.2010.03813.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Seirafi H, Farnaghi F, Vasheghani-Farahani A, Alirezaie NS, Esfahanian F, Firooz A, Ghodsi SZ. Assessment of androgens in women with adult-onset acne. Int J Dermatol 2007; 46:1188-91. [DOI: 10.1111/j.1365-4632.2007.03411.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Souter I, Sanchez LA, Perez M, Bartolucci AA, Azziz R. The prevalence of androgen excess among patients with minimal unwanted hair growth. Am J Obstet Gynecol 2004; 191:1914-20. [PMID: 15592272 DOI: 10.1016/j.ajog.2004.06.064] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The prevalence of androgen excess (AE) and the value of preemptive endocrine evaluation in women with minimal unwanted hair growth are unclear. SUBJECTS A total of 228 patients presented with minimal unwanted hair growth and a mF-G score of 5 or less. Total and free testosterone, dehydroepiandrosterone sulfate, 17-hydroxy-progesterone, sex hormone-binding globulin, and basal insulin and glucose levels were measured. RESULTS Of the patients, 54% demonstrated an AE disorder (50%: polycystic ovary syndrome, 2%: hyperandrogenic insulin-resistant acanthosis nigricans syndrome, 2%: nonclassic adrenal hyperplasia), 29% isolated oligoovulation, 6% isolated hyperandrogenemia, and 10% had a normal evaluation. Of the patients with menstrual irregularities, 65% had an underlying AE disorder compared with 22% of those with normal menstrual function ( P < .001). Of eumenorrheic patients, 11% had oligo-ovulation and an AE disorder. CONCLUSION Patients with minimal unwanted hair growth should be evaluated endocrinologically because approximately 50% of subjects demonstrate an AE disorder. Eumenorrhea does not preclude an underlying AE disorder, and ovulatory function should be assessed in these women.
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Affiliation(s)
- Irene Souter
- Department of Obstetrics/Gynecology, Cedars-Sinai Medical Center, Los Angeles, Calif, USA
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Abstract
OBJECTIVE To determine whether acne is associated with hyperandrogenemia, regardless of age of presentation. DESIGN Prospective controlled study. SETTING Tertiary-care medical center. PATIENT(S) Thirty consecutive unselected women presenting with acne and no hirsutism and 24 eumenorrheic healthy controls. INTERVENTION(S) Serum samples was taken in all patients, and an acute 60-minute ACTH-(1-24) test was performed in 19 patients. MAIN OUTCOME MEASURE(S) Total and free T, sex hormone-binding globulin (SHBG), and DHEAS levels in basal samples, and ACTH-stimulated 17-hydroxyprogesterone (17-HP) response to exclude 21-hydroxylase (21-OH)-deficient nonclassic adrenal hyperplasia (NCAH) were determined. RESULT(S) Nonhirsute patients with acne demonstrated significantly lower levels of SHBG and higher free-T and DHEAS levels than controls. Nineteen (63%) acneic patients had at least one androgen value above the 95% of controls. In patients aged 12-18 years, 7/8 (88%) had at least one increased androgen value, compared with 12/22 (55%) patients aged 19-43 years. One patient (5.3%) was found to have 21-OH-deficient NCAH. CONCLUSION(S) Hyperandrogenemia was evident in a majority of nonhirsute acneic patients studied, regardless of age. These data suggest that androgen suppression may be useful in treating acne in many of these patients.
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Affiliation(s)
- S M Slayden
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama 35249-7333, USA
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Goulden V, McGeown CH, Cunliffe WJ. The familial risk of adult acne: a comparison between first-degree relatives of affected and unaffected individuals. Br J Dermatol 1999; 141:297-300. [PMID: 10468803 DOI: 10.1046/j.1365-2133.1999.02979.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Acne is principally a disorder of adolescence but persists into middle age in a small minority of individuals. There is some evidence, primarily from twin studies, to suggest that acne may be an inherited disease. We have carried out an investigation of the familial risk of persistent adult acne by studying the occurrence of this condition in first-degree relatives of patients with adult persistent acne compared with the relatives of unaffected matched controls. Two hundred and four patients over the age of 25, referred to our department with facial acne which had persisted from adolescence, were included in the study. For each patient, a detailed pedigree which included all first-degree relatives was drawn up. For all relatives over the age of 25, demographic details and the presence or absence of facial acne was recorded. One hundred and forty-four unaffected controls were recruited. These were matched with the patient group in terms of age, social class and ethnic origin. The same questions were asked of controls as of the cases, and they provided the same information on their first-degree relatives. In total, 204 acne cases and 144 non-acne control volunteers were studied, contributing 1203 and 856 first-degree relatives, respectively. Two hundred and three first-degree relatives of cases were affected with facial acne, compared with 42 first-degree relatives of volunteers. The risk of adult acne occurring in a relative of a patient with adult acne was significantly greater than for the relative of an unaffected individual (odds ratio 3.93, 95% confidence interval 2.79-5.51; P < 0.001). Our study suggests that familial factors are important in determining individual susceptibility to adult persistent facial acne. Genetic factors may determine the failure of acne-prone follicles to evolve into acne-resistant follicles in early adult life.
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Affiliation(s)
- V Goulden
- Department of Dermatology, The General Infirmary at Leeds, Leeds LS1 3EX, UK
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Abstract
The purpose of this study was to evaluate serum levels of basal insulin and glucose-stimulated insulin, and to evaluate their correlations with androgen levels in women with acne. Serum levels of total testosterone (T), free testosterone (FT), dihydrotestosterone (DHT), dehydroepiandrosterone sulfate (DHEA-S), sex hormone binding globulin (SHBG), insulin-like growth factor-1 (IFG-1), and immunoreactive insulin (IRI) were measured and compared in thirty women with moderate or severe acne and thirteen healthy controls. Serum FT, DHT and DHEA-S levels in the acne group were significantly higher than those in the control group. In the acne group, there were no significant correlations between insulin or IGF-1 levels and T, FT, DHT and SHBG, despite the positive correlation between insulin and IGF-1. In order to determine the effects of insulin secretion as a dynamic response to an oral glucose tolerance test (OGTT) on serum androgen levels in acne patients, we examined the responses of serum insulin and androgen levels to a 75 g, 2 hour OGTT in the acne group and in the control group. Basal insulin levels were not significantly higher than those in the control group, but the summed insulin levels during the OGTT in the acne group were significantly higher than those in the control group. Serum T and FT levels in the acne group decreased during the OGTT, but these changes were not so significant when compared to normal controls. In conclusion, we tried to demonstrate mild insulin resistance during the OGTT in acne patients. However, postmeal transient hyperinsulinemia does not seem to play an important role in determining hyperandrogenemia in acne patients.
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Affiliation(s)
- H Aizawa
- Department of Dermatology, Jikei University School of Medicine, Tokyo, Japan
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Abstract
Androgens are essential for the development of acne. The object of this study was to elucidate the androgen status of women with adolescent (Tanner's stage IV-V) acne alone and compare them to age-matched normal controls. We measured serum levels of total testosterone (T), free testosterone (FT), dihydrotestosterone (DHT), and dehydroepiandrosterone sulfate (DHEA-S) in 15 women with adolescent acne and 13 age-matched healthy controls. No significant differences were found between the mean levels of T, FT or DHT levels in patients and controls. However, the mean levels of DHEA-S in the patient population (1886 +/- 829 ng/ml) were significantly (p < 0.05) higher than normal controls (1287 +/- 620 ng/ml). There was also no correlation between androgen levels and acne severity. Thus it is unlikely that serum androgens play a principal role in women with adolescent acne.
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Affiliation(s)
- H Aizawa
- Department of Dermatology, Jikei University School of Medicine, Tokyo, Japan
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Aizawa H, Niimura M. Elevated serum insulin-like growth factor-1 (IGF-1) levels in women with postadolescent acne. J Dermatol 1995; 22:249-52. [PMID: 7608381 DOI: 10.1111/j.1346-8138.1995.tb03381.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The purpose of this study was to measure the serum levels of IGF-1 in women with postadolescent acne compared to normal controls, and evaluate the relationship of these levels to the levels of androgens, in order to investigate the possible role of IGF-1 in the pathogenesis of acne. Eighty-two female patients with acne between 20 and 25 years of age and thirty-one age-matched control women were studied. We measured the serum levels of total testosterone (T), free testosterone (FT), dihydrotestosterone (DHT), dehydroepiandrosterone sulfate (DHEA-S), and insulin-like growth factor-1 (IGF-1). The levels of IGF-1 in patients with acne (1.26 +/- 0.52 U/ml) were significantly (p < 0.001) increased over those of controls (0.96 +/- 0.32 U/ml). Of 82 acne patients, six (7%) had IGF-1 levels which exceeded the normal range, but there were no significant correlations between IGF-1 and T, FT, DHT or DHEA-S levels or between IGF-1 and acne severity. Since the measurement of serum IGF-1 levels is a convenient indicator of GH secretion, the increase of serum IGF-1 levels seen in some acne patients might reflect an increase of GH.
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Affiliation(s)
- H Aizawa
- Department of Dermatology, Jikei University School of Medicine, Tokyo, Japan
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