Shaw James C
Division of Dermatology, University of Toronto, Toronto Western Hospital, 355 Bathurst Street EW 8-517, Toronto, M5T 258 Ontario, Canada.
Am J Clin Dermatol. 2002;3(8):571-8. doi: 10.2165/00128071-200203080-00007.
In the pathogenesis of acne, androgen hormones play a crucial role. In the treatment of acne, hormonal therapies provide valuable alternatives to standard modalities in selected women. Although numerous factors contribute to the development of acne, the requirement for androgens is absolute and is one that allows for effective treatments in women through inhibition of androgen expression. The two prerequisites for androgen expression at the level of the pilosebaceous unit are the presence of androgen in the form of either testosterone or dihydrotestosterone; and functioning androgen receptors. A third component may be the metabolism of androgen precursors to active androgens within pilosebaceous units. Hormonal treatment of hyperandrogenism (acne, hirsutism, androgenetic alopecia) such as that seen in polycystic ovary syndrome, centers on reduction of circulating androgen levels and androgen receptor blockade. Combination oral contraceptives represent the primary treatment modality for reducing circulating androgens from ovarian and, to a lesser degree, adrenal sources. Newer formulations may also have clinically significant androgen receptor blocking and 5alpha-reductase inhibiting effects. Newer oral contraceptives have high safety profiles and are used widely internationally for this purpose. Androgen receptor blockers currently in use include spironolactone, cyproterone acetate, and flutamide. Androgen receptor blockers are frequently combined with oral contraceptives to achieve optimal results in selected women. In women with adrenal hyperplasia, low-dose corticosteroids may be added to reduce adrenal androgen precursors. Inhibition of enzymes of androgen metabolism in the pilosebaceous unit remain largely investigational in the treatment of acne, although the benefit of 5alpha-reductase (type 2) inhibition is established in androgenetic alopecia in men. This article reviews the essentials of hormonal influence in acne pathogenesis, discusses the hormonal therapies most utilized in the treatment of acne, and the pre-treatment evaluation of women in whom hormonal therapies are being considered.
在痤疮的发病机制中，雄激素起着至关重要的作用。在痤疮治疗中，对于特定女性而言，激素疗法为标准治疗方式提供了有价值的替代方案。尽管痤疮的发生有众多因素，但雄激素的作用是绝对必要的，这使得通过抑制雄激素表达对女性进行有效治疗成为可能。在毛囊皮脂腺单位水平上雄激素表达的两个先决条件是睾酮或二氢睾酮形式的雄激素的存在以及有功能的雄激素受体。第三个因素可能是毛囊皮脂腺单位内雄激素前体向活性雄激素的代谢。对多囊卵巢综合征等所见的高雄激素血症（痤疮、多毛症、雄激素性脱发）的激素治疗，主要围绕降低循环雄激素水平和雄激素受体阻断展开。复方口服避孕药是降低来自卵巢以及程度较轻的肾上腺来源的循环雄激素的主要治疗方式。新型制剂可能还具有临床上显著的雄激素受体阻断和5α-还原酶抑制作用。新型口服避孕药具有较高的安全性，为此在国际上被广泛使用。目前使用的雄激素受体阻断剂包括螺内酯、醋酸环丙孕酮和氟他胺。雄激素受体阻断剂常与口服避孕药联合使用，以便在特定女性中取得最佳效果。对于肾上腺增生的女性，可加用低剂量皮质类固醇以减少肾上腺雄激素前体。在痤疮治疗中，毛囊皮脂腺单位内雄激素代谢酶的抑制在很大程度上仍处于研究阶段，尽管5α-还原酶（2型）抑制对男性雄激素性脱发的益处已得到证实。本文综述了激素对痤疮发病机制影响的要点，并讨论了痤疮治疗中最常用的激素疗法以及考虑采用激素疗法的女性的治疗前评估。
