Hormonal Treatment of Acne
Acne is a disease of the pilosebaceous units and these are mainly under hormonal control. In the treatment of acne in women, the use of antiandrogens and other hormonal approaches is an important alternative to standard therapy. These treatments that are based on physiologically sound principles produce gratifying results in selected women with acne. Androgens that play a part in causing acne involve 5-dihydrodrotestosterone (DHT), testosterone (T), androstenedione (A), and dehydroepiandrosterone-sulfate (DHEA-S). The production of these androgens from ovaries and adrenal glands is mediated by gonadotrophins.
Levels of testosterone are inversely associated to levels of sex hormone binding globulin (SHBG), so that if T increases, SHBG decreases and when T is reduced, SHBG increases. Polycystic ovarian syndrome is a condition originates in women who have very high androgen and testosterone levels.
This condition affects 5-10% of women in their reproductive years. Hormonal treatment of acne, limited to women, offers a different approach that is helpful when other treatments are ineffective. Women who benefit most from hormonal treatment are typically in their 20s or 30s, have acne on the lower part of the face and neck, and have a history of failed treatment, or intolerance to standard acne therapies.
Hormonal treatment is generally not used in the most severe forms of acne, nodular/cystic acne. Most acne treatments require prolonged care, from months to years. Women who develop adult acne typically have the problem for years, frequently through menopause.
The modalities employed most in hormonal acne treatment are oral contraceptives and anti-androgens.
It is common to begin with oral contraceptives for one to two months, as sometimes just regulating the menstrual cycle is adequate to stop the acne. Often this is only partly effective, and then we add anti-androgens. The combination is particularly effective.
Hormonal therapy is fit for adult women or teenage girls who have gone through antibiotics or topical medications but have not seen much consequence.
Women have the choice of using hormonal treatment for acne such as Dianette (ethinyloestradiol with cyproterone acetate). Diannette carries an elevated risk of thrombosis than ordinary low-dose contraceptive pills, so is usually reserved for severe acne. A month after the acne has gone.
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