Feily Amir, Taheri Tahere, Meier-Schiesser Barbara, Rhinehart Dena P, Sobhanian Saeed, Colon-Diaz Maricarmen, Feily Ahmad, Ramirez-Fort Marigdalia K
Dermatology, Jahrom University of Medical Sciences, Jahrom, Iran.
Student Research Committee, Jahrom University of Medical Sciences, Jahrom, Iran.
Int J Womens Dermatol. 2019 Nov 14;6(2):102-104. doi: 10.1016/j.ijwd.2019.10.007. eCollection 2020 Mar.
Acne vulgaris is a common dermatologic disease that causes significant social and psychological morbidity. Isotretinoin, as a vitamin A derivative, is the most effective agent in the treatment of acne. Evidence suggests that isotretinoin's therapeutic function is independent of hormonal mediation; however, the effect of isotretinoin on serum androgens and precursor androgen levels in humans remains unclear.
Herein, we aim to investigate the effect of low-dose isotretinoin on androgen levels in women and postulate the role of concomitant anti-androgen therapy (e.g., spironolactone).
A total of 36 women, age 18 to 30 years, with moderate-to-severe nodulocystic acne were treated with 20 mg isotretinoin (Roaccutane) daily for 3 months. A hormone panel was obtained at baseline and after completion of the treatment course. The panel included dehydroepiandrosterone (DHEA), 17-hydroxyprogestrone, testosterone, free testosterone, dihydrotestosterone (DHT), luteinizing hormone, follicle stimulating hormone, and prolactin.
Serum levels of testosterone (p = .015), prolactin (p = .001), and DHT (p = .001) were significantly decreased, while serum levels of DHEA (p = .001) significantly increased after isotretinoin treatment. No significant change was found in the other hormones evaluated.
The distribution of acne was not assessed in our patient population. We did not directly evaluate for associations between elevated DHEA levels and clinical response rates.
Isotretinoin alone can decrease androgen levels, but increase an important driver of acne pathogenesis (i.e., DHEA). The co-administration of an anti-androgenic agent (e.g., spironolactone) may optimize the therapeutic efficacy of isotretinoin by limiting iatrogenic increases in DHEA and perhaps allow for more widespread use of low-dose isotretinoin.
寻常痤疮是一种常见的皮肤病，会导致严重的社会和心理问题。异维A酸作为一种维生素A衍生物，是治疗痤疮最有效的药物。有证据表明异维A酸的治疗作用独立于激素介导；然而，异维A酸对人体血清雄激素和雄激素前体水平的影响仍不清楚。
在此，我们旨在研究低剂量异维A酸对女性雄激素水平的影响，并推测联合抗雄激素治疗（如螺内酯）的作用。
共有36名年龄在18至30岁之间、患有中度至重度结节囊肿性痤疮的女性，每天服用20毫克异维A酸（泰尔丝），持续3个月。在基线和治疗疗程结束后进行激素检测。检测项目包括脱氢表雄酮（DHEA）、17-羟孕酮、睾酮、游离睾酮、双氢睾酮（DHT）、促黄体生成素、促卵泡生成素和催乳素。
异维A酸治疗后，血清睾酮水平（p = 0.015）、催乳素水平（p = 0.001）和双氢睾酮水平（p = 0.001）显著降低，而血清脱氢表雄酮水平（p = 0.001）显著升高。其他评估的激素水平未发现显著变化。
我们的患者群体未评估痤疮的分布情况。我们没有直接评估脱氢表雄酮水平升高与临床反应率之间的关联。
单独使用异维A酸可降低雄激素水平，但会增加痤疮发病机制的一个重要驱动因素（即脱氢表雄酮）。联合使用抗雄激素药物（如螺内酯）可能通过限制医源性脱氢表雄酮增加来优化异维A酸的治疗效果，并且可能允许更广泛地使用低剂量异维A酸。
