Gayen Rumi, Podder Indrashis, Chakraborty Indranil, Chowdhury Satyendra Nath
Department of Biochemistry College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India.
Department of Dermatology, Venereology and Leprosy, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India.
Indian J Dermatol. 2021 Jan-Feb;66(1):60-66. doi: 10.4103/ijd.IJD_82_20.
Acne vulgaris is a common dermatological disorder. Several hormones are suspected to play a role in its etiopathogenesis.
The aim of this study was to analyze the role of sex-hormones, metabolic status, and obesity in acne vulgaris and correlate with its severity and symptom load.
This cross-sectional observational study included 89 female patients with acne vulgaris and certain phenotypic markers such as prepubertal onset, late-onset, persistent course, hirsutism, acanthosis nigricans, acrochordons, premenstrual flare, and diminished response to isotretinoin; suggestive of an underlying hormonal pathology. All patients were subjected to physical examination to rule out obesity and metabolic syndrome along with serum biochemistry to detect sex hormones (testosterone, progesterone, estrogen), serum insulin and insulin resistance (HOMA-IR) and lipid profile.
Among 89 patients (mean age 21.3 ± 5.3 years), 34.8% presented with late-onset/persistent/pre-pubertal acne, 33.7% presented with premenstrual flare and 28.2% presented with hirsutism. Hormonal analysis revealed elevated testosterone and progesterone with low estrogen across all categories of patients. Testosterone was significantly elevated even in mild acne. Serum lipid profile was altered significantly only in hirsute females. In total, 36% and 20.2% patients presented with metabolic syndrome and obesity, respectively; however, neither was associated with severity of acne.
Sex-hormones, serum lipids, metabolic status, and body mass index are altered in acne vulgaris. All acne patients with endocrine markers should be evaluated for sex-hormones irrespective of severity and symptom load, whereas hirsutism may be regarded as clinical marker of lipid abnormalities. Metabolic syndrome and obesity do not seem to be directly correlated with acne severity. Thus, anti-androgens may be considered as adjuvant therapy in these patients, not responding to conventional therapy.
寻常痤疮是一种常见的皮肤病。有几种激素被怀疑在其发病机制中起作用。
本研究旨在分析性激素、代谢状态和肥胖在寻常痤疮中的作用，并将其与痤疮的严重程度和症状负荷相关联。
这项横断面观察性研究纳入了89例患有寻常痤疮且具有某些表型特征的女性患者，这些特征包括青春期前发病、迟发性、病程持续、多毛、黑棘皮病、皮赘、经前加重以及对异维A酸反应减弱，提示存在潜在的激素病理状态。所有患者均接受体格检查以排除肥胖和代谢综合征，并进行血清生化检查以检测性激素（睾酮、孕酮、雌激素）、血清胰岛素和胰岛素抵抗（HOMA-IR）以及血脂谱。
在89例患者（平均年龄21.3±5.3岁）中，34.8%表现为迟发性/持续性/青春期前痤疮，33.7%表现为经前加重，28.2%表现为多毛。激素分析显示，所有类型患者的睾酮和孕酮升高，雌激素降低。即使是轻度痤疮患者，睾酮也显著升高。仅多毛女性的血脂谱有显著改变。总体而言，分别有36%和20.2%的患者患有代谢综合征和肥胖；然而，两者均与痤疮严重程度无关。
寻常痤疮患者的性激素、血脂、代谢状态和体重指数均发生改变。所有具有内分泌标志物的痤疮患者，无论严重程度和症状负荷如何，均应评估性激素，而多毛可被视为脂质异常的临床标志物。代谢综合征和肥胖似乎与痤疮严重程度无直接关联。因此，对于这些对常规治疗无反应的患者，可考虑将抗雄激素作为辅助治疗。
