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[QUOTE] Rev Prat. 2002 Apr 15;52(8):850-3. Related Articles, Links

[Acne and hormones]

[B][Article in French][/B]

Faure M.

Clinique dermatologique, Hopital Edouard-Herriot 69347 Lyon.

[B]Androgens stimulate sebum production which is necessary for the development of acne.[/B] Acne in women may thus be considered as a manifestation of cutaneous androgenization. [B]Most of acnes may be related to an idiopathic skin hyperandrogenism due to in situ enzyme activity and androgen receptor hypersensitivity, as also noted in idiopathic hirsutism. [/B] Some acne may correspond to elevated ovarian or adrenal androgen secretion. The presence of acne in women may lead to a diagnosis of functional hyperandrogenism, either polycysticovary syndrome or nonclassical 21-hydroxylase deficiency. Plasma level assays for testosterone, delta 4 androstenedione and 17-OH progesterone and ovarian echography are necessary to determine the possibility for an ovarian or adrenal hyperandrogenism, but not to better treat acne. The goal of hormonal therapy in acne is to oppose the effects of androgens on the sebaceous gland. Hormones may be used in female acne in the absence of endocrine abnormalities. Antiandrogens (cyproterone acetate or aldactone) may be useful in severe acne, hormonal contraceptives with cyproterone acetate or non androgenic progestins in mild or common acne often in association with other anti-acneic drugs. Glucocorticoids have to be administered in acne fulminans and other forms of acute, severe, inflammatory acne, for their anti-inflammatory properties.[/QUOTE] [url][/url]

Unfortunately I think the problem is that they don't want to admit that androgens is THE cause. Of course nothing is ever 100% certain, but they have known about the connection for over 30 or 40 years now. For woman, no problem they'll give us a variety of anti-androgens, but for males....good luck! What I've noticed is that males hardly ever see an endocrinoligist let alone will get their hormones tested despite insisting on it, and I think it's because of the fear of becoming demasculinized as androgens is a "male hormone". Usually what happens is males will use androgen antagnonists, such as Accutane (Isotretinion, 13-Cis retinoic acid) or select topicals, that don't emit much, if any, action on total serum androgen production, but mainly affect the skin. Granted there's a few males here that have managed to go on Spironolactone (antiandrogen) and cleared, but yes...something else was altered as result.

None the less, for males the sign of a hormonal imbalance, will be the acne or eventual androgenic alopecia (male patterned baldness) or prostate BPH or cancer (see below). So there really isn't a big push to announce that it's androgens because males don't really show it as easily as women do. Therefore from what I've noticed, if you guys don't use dietary changes to balance your hormones & thus inflammation, you tend to do very well on drugs/supplements that are generally anti-inflammatory (B5, Nicomide, Glucocorticoids, Boswellic Acid, Fish Oil, Guggulipids, Zinc), but some are also androgen antagonists. After all, if you can reduce the inflammation, most acne formation probably wouldn't result...but whatever we do use for this, antibiotics are NOT the solution.

[QUOTE] Br J Dermatol. 2003 Jun;148(6):1263-6. Related Articles, Links

[B]Congenital adrenal hyperplasia and acne in male patients.[/B]

Degitz K, Placzek M, Arnold B, Schmidt H, Plewig G.

Department of Dermatology, Ludwig-Maximilian-University, Munchen, Germany.

Seborrhoea is one pathogenic factor for acne. Androgens induce sebum production, and excess androgen may provoke or aggravate acne. In women an androgen disorder is frequently suspected when acne is accompanied by hirsutism or menstrual irregularities. In men acne may be the only symptom of androgen excess. We report three male acne patients in whom hormonal screening revealed irregularities of androgen metabolism suggestive of late-onset congenital adrenal hyperplasia and who benefitted from low-dose glucocorticoids. Disorders of androgen metabolism may influence acne not only in women, but also in men, and these patients may benefit from low-dose glucocorticoid therapy.[/QUOTE]


[QUOTE]Dermatology. 1998;196(1):153-7. Related Articles, Links

[QUOTE]Other antiandrogens.[/QUOTE]

Schmidt JB.

Department of Dermatology, University of Vienna Medical School, Austria.

Various substances of steroidal or nonsteroidal structure may serve as an alternative for the antiandrogenic treatment of acne. Compounds with antiandrogenic properties like cimetidine or ketoconazole are rarely administered for acne due to their weak effects. In contrast, [B]spironolactone is an effective antiandrogen that shows good treatment effects in hirsutism and acne.[/B] Side effects occur frequently and are dose dependent. [B]Isotretinoin--the most effective agent in acne therapy--has been under discussion for additional antiandrogenic properties for years. At present there is additional evidence for the antiandrogenic effects of isotretinoin. Regarding substances acting on both levels, androgen receptor binding and 5 alpha-reductase inhibition,[/B] the question is raised whether the term 'antiandrogen' should be amplified by including the 5 alpha-reductase inhibitors. This would pay tribute to the biological aspect of antiandrogenicity that takes into account not only the mode of action but also the effects of the substance. Under this aspect type 1 5 alpha-reductase inhibitors may gain attention in the future.[/QUOTE] [url][/url]

[QUOTE]J Clin Endocrinol Metab. 1995 Apr;80(4):1158-61. Related Articles, Links

[B]Effect of oral isotretinoin treatment on skin androgen receptor levels in male acneic patients.[/B]

Boudou P, Soliman H, Chivot M, Villette JM, Vexiau P, Belanger A, Fiet J.

Department of Hormonal Biology, St. Louis University Hospital, Paris, France.

An oral daily dose (mean +/- SD, 0.75 +/- 0.05 mg/kg) of isotretinoin was administered for 3 months to six male patients with acne (scores of 4 and 5 according to Rosenfield). The therapy resulted in complete resolution of acne in four patients and improved acne significantly (score 1) in two patients. In accordance with recent findings,[U] no change in serum testosterone [/U] and [B]significant decreases in 5 alpha-dihydrotestosterone, 5 alpha-androstane-3 alpha,17 beta-diol glucosiduronate, and androsterone glucosiduronate levels were observed after treatmen[/B]t. Androgen receptor status was investigated in back skin biopsies obtained in acne areas before and after 3 months of isotretinoin treatment. The treatment did not modify the binding affinity constant of skin androgen receptor (0.44 vs. 0.32 nmol/L), but it did induce a 2.6-fold [U]decrease in its binding capacity [/U] constant (62 vs. 24 fmol/mg cytosolic protein), as assessed by Scatchard plot and confirmed immunologically by Western blot analysis. These data clearly showed that skin androgen receptor was sensitive to oral isotretinoin administration in acneic patients. [B]The decrease in skin androgen receptor levels (this study) and the recently reported suppression of skin 5 alpha-dihydrotestosterone production by isotretinoin treatment appeared consistent with the involvement of androgen receptor and 5 alpha-dihydrotestosterone in the pathogenesis of acne. [/B] Indeed, [U]sebum production is under androgen control, and an abnormal response of the pilosebaceous unit to androgens appears to be implicated in the pathogenesis of acne.[/U] These observations were consistent with the absence of sebum in complete androgen-insensitive patients and normal sebum production in male pseudohermaphrodites. [/QUOTE] [url][/url]

[QUOTE]Ann Dermatol Venereol. 1999 Jan;126(1):17-9. Related Articles, Links

[Acne in the male resistant to isotretinoin and responsibility of androgens: 9 cases, therapeutic implications][/B]

[Article in French]

Chaspoux C, Lehucher-Ceyrac D, Morel P, Lefrancq H, Boudou P, Fiet J, Vexiau P.

Service d'Endocrinologie, Hopital Saint-Louis, Paris.

INTRODUCTION: [U]Treatment failures with isotretinoin [/U] in female patients are frequently related to endocrinological dysfunctions. [U]Such a concept has never been discussed in male patients[/U]. CASE REPORTS: An extensive endocrinological work-up has been performed in nine male patients who presented with an acne refractory to conventional treatment and to isotretinoin. [b]Adrenal dysfunction [/b] was found in four patients and isolated[b] 5-alpha reductase hyperactivity [/b] in 2 cases. Three work-ups were normal. A suppressive treatment in three patients with adrenal dysfunction provided immediate efficacy. COMMENTS: These results would provide insight into the mechanism of refractory acne in men.[/QUOTE] [url][/url]

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