Cibula D, Hill M, Fanta M, Skrenková J, Vohradníková O, Kudynová J, Zivný J
Gynek.-porod. klinika 1. LF UK a VFN, Praha.
Ceska Gynekol. 1999 Jul;64(4):242-6.
The aim of our study was to identify clinical parameters characterizing women with acne whose dermatological problems are due to increased androgen production. Identification of these parameters would allow to indicate endocrinological examination in only a proportion of women with acne vulgaris.
A total of 54 women with acne vulgaris resistant to local treatment were enrolled in the study. The following clinical parameters were monitored: hirsutism (Ferriman-Gallway score), severity of acne, association of the severity of acne with the menstrual cycle, beginning of manifestations of acne, regularity of the menstrual cycle, presence of alopecia, age at menarche, body weight, BMI and ultrasound investigation of the ovaries. In the standard phase of the cycle, blood was collected to determine the levels of the following hormones: LH, FSH, PRL, TSH, testosterone, androstenedione, DHEA, DHEAS, SHGB. Wilcoxon's robust non-parametric paired test was employed for statistical data analysis.
Overall, 33 (61%) women showed increased levels of at least one androgen. An irregular cycle was found in 21 (39%) women, acne severity was associated with the menstrual cycle in 16 (30%) women, 48 (89%) women had acne from menarche, 19 (35%) women had hirsutism; an ultrasound finding of polycystic ovaries was revealed in 32 (59%) women. No significant differences were found between a sub-group of women with levels of at least one androgen above the upper reference limit and the other women in the following variables: age, weight, BMI, age at menarche, ultrasound finding of polycystic ovaries, manifestation of acne from menarche, irregular cycle, hirsutism. The two groups were not different in the severity of acne. Deterioration of acne depending on the menstrual cycle was more often present in women with normal androgen levels. By contrast, a regular menstrual cycle was found to be more frequent in women with raised androgen levels, although the difference was not statistically significant.
Clinical parameters had no association with androgen overproduction. Evaluation of clinical parameters, including severity of acne, does not allow to refer only a proportion of women with acne resistant to local treatment for endocrinological examination.
我们研究的目的是确定那些皮肤病问题源于雄激素分泌增加的痤疮女性患者的临床特征参数。确定这些参数将使我们仅能对一部分寻常痤疮女性患者进行内分泌检查。
共有54名对局部治疗无效的寻常痤疮女性患者纳入本研究。监测了以下临床参数：多毛症（费里曼-高尔韦评分）、痤疮严重程度、痤疮严重程度与月经周期的关系、痤疮开始出现的时间、月经周期规律、脱发情况、初潮年龄、体重、体重指数以及卵巢超声检查。在月经周期的标准阶段，采集血液以测定以下激素水平：促黄体生成素（LH）、促卵泡生成素（FSH）、催乳素（PRL）、促甲状腺激素（TSH）、睾酮、雄烯二酮、脱氢表雄酮（DHEA）、硫酸脱氢表雄酮（DHEAS）、性激素结合球蛋白（SHGB）。采用威尔科克森稳健非参数配对检验进行统计数据分析。
总体而言，33名（61%）女性至少有一种雄激素水平升高。21名（39%）女性月经周期不规律，16名（30%）女性痤疮严重程度与月经周期有关，48名（89%）女性自初潮起就有痤疮，19名（35%）女性有多毛症；32名（59%）女性超声检查发现多囊卵巢。至少有一种雄激素水平高于参考上限的女性亚组与其他女性在以下变量方面未发现显著差异：年龄、体重、体重指数、初潮年龄、多囊卵巢的超声检查结果、自初潮起出现痤疮、月经周期不规律、多毛症。两组在痤疮严重程度上无差异。雄激素水平正常的女性中，痤疮随月经周期恶化的情况更为常见。相比之下，雄激素水平升高的女性月经周期更规律，尽管差异无统计学意义。
临床参数与雄激素分泌过多无关。对包括痤疮严重程度在内的临床参数进行评估，并不能仅让一部分对局部治疗无效的痤疮女性患者接受内分泌检查。
