Acne Vulgaris in Adult Females: Hormonal treatment (For Professionals)

• Hormonal therapies (antiandrogens) such as oral contraceptives and spironolactone are often used in the treatment of acne, particularly in adult women.
• It is therefore sometimes useful to run blood tests in acne patients entering this category, morevover when there is a clinical suspicion of virilizing ovarian tumors, polycystic ovarian syndrome (PCOS), congenital adrenal hyperplasia (CAH). Recalcitrant/ persistant cases of acne in adult women should also be tested.

• if levels are normal: treat for acne in a stepwise fashion
• if the testosterone level elevated

1. highly elevated: suspect ovarian tumor. Refer to gynaecologist, and then treat with antiandrogens
2. mildly increased or if LH/FSH ratio higher than 2:3: suspect PCOS. Refer to gynaecologist and then treat with antiandrogens
3. with increased DHEA: suspect CAH. Test for 17-hydroxyprogesterone and refer to endocrinologist. Then treat with antiandrognes

This advice is for informational purposes  only and does not replace therapeutic judgement done by a skin doctor.

Contributors:

Dr Christophe Hsu – dermatologist. Geneva, Switzerland

Bibliography: Ruth, C; Acne, P3-6; Supplement to Dermatology World, JAAD; May 2012