Dhaher Samer A, Hamdan Ahmed, Alyasin Zainab T
Department of Dermatology, College of Medicine, University of Basrah, Basrah, IRQ.
Department of Dermatology, Basrah Teaching Hospital, Basrah Health Directorate, Basrah, IRQ.
Cureus. 2022 Dec 23;14(12):e32866. doi: 10.7759/cureus.32866. eCollection 2022 Dec.
Background Acne vulgaris is a common chronic inflammatory disease of the pilosebaceous units associated with long-term sequelae and complications. Currently, acne in women is classified into adolescent and post-adolescent forms. However, comparative studies evaluating the clinical and laboratory parameters across various age groups in women with acne are lacking. The aim of the study is to compare the clinical and laboratory characteristics of different groups of women with acne vulgaris. Patients and methods Over 3 years (2018-2021), a cross-sectional study was carried out on 340 women with acne consulting the Dermatology and Venereology Outpatient Clinic, Basrah Teaching Hospital, Basrah, Iraq. Eligible patients were carefully evaluated and fully examined, emphasizing on signs of hyperandrogenism and scoring of acne severity. Hormonal assays of serum total testosterone (TST), dehydroepiandrosterone sulfate (DHEAS), luteinizing hormone (LH), follicular stimulating hormone (FSH), and serum prolactin (PRL) were done. Pelvic ultrasonography was performed to identify any pelvic pathology. The patients were classified according to their age of onset. Clinical and laboratory data were compared among groups. Results Three groups were recognized: 160 patients (47%) with adolescent acne (AA) (mean age SD: 17.2±1.6 years), 80 (23.5%) with early adult-onset acne (EA) (mean age SD: 21.4±1.2 years), and 100 (29.4%) with post-adolescent acne (PA) (mean age SD: 28.7±2.9 years), which were further sub-grouped into late-onset acne (40 cases, 11.7%), and persistent acne (60 cases, 17.6%). The mean body mass index was normal in the AA group and overweight in the EA and PA groups. Moderate obesity was more frequent in PA (24%, p=0.03). While 78.5% of AA was mild to moderate acne, 77.5% of EA was moderate to moderately severe, and 72% of PA was moderately severe to severe. Clinical and biochemical markers of hyperandrogenism were seen in all groups, however, they were more frequent in PA and EA groups than in the AA group (p<005). Conclusion Clinical and biochemical hyperandrogenism were present in a significant proportion of women with acne; their prevalence was higher in post-adolescent acne than in adolescent acne. Acne that began between the ages of 20 and 25 was classified as "early adult-onset acne," and showed variable features of hyperandrogenism. A complete evaluation, regardless of age, for every female with acne, including a hormonal analysis and pelvic ultrasound examination to detect hormonal imbalances as early therapy, can help to prevent and reduce the risk of consequences.
背景 寻常痤疮是一种常见的毛囊皮脂腺单位慢性炎症性疾病，伴有长期后遗症和并发症。目前，女性痤疮分为青春期和青春期后两种类型。然而，缺乏评估不同年龄组女性痤疮临床和实验室参数的比较研究。本研究的目的是比较不同组寻常痤疮女性的临床和实验室特征。
患者与方法 在3年（2018 - 2021年）期间，对伊拉克巴士拉巴士拉教学医院皮肤科和性病门诊就诊的340例痤疮女性患者进行了横断面研究。对符合条件的患者进行了仔细评估和全面检查，重点关注高雄激素血症体征和痤疮严重程度评分。进行了血清总睾酮（TST）、硫酸脱氢表雄酮（DHEAS）、黄体生成素（LH）、卵泡刺激素（FSH）和血清催乳素（PRL）的激素检测。进行盆腔超声检查以确定是否存在盆腔病变。根据发病年龄对患者进行分类。比较各组之间的临床和实验室数据。
结果 共识别出三组：160例（47%）青春期痤疮（AA）患者（平均年龄标准差：17.2±1.6岁），80例（23.5%）早发性成人痤疮（EA）患者（平均年龄标准差：21.4±1.2岁），以及100例（29.4%）青春期后痤疮（PA）患者（平均年龄标准差：28.7±2.9岁），PA组进一步细分为迟发性痤疮（40例，11.7%）和持续性痤疮（60例，17.6%）。AA组平均体重指数正常，EA组和PA组超重。PA组中度肥胖更为常见（24%，p = 0.03）。AA组78.5%为轻度至中度痤疮，EA组77.5%为中度至中度重度痤疮，PA组72%为中度重度至重度痤疮。所有组均可见高雄激素血症的临床和生化标志物，然而，PA组和EA组比AA组更常见（p < 0.05）。
结论 相当比例的痤疮女性存在临床和生化高雄激素血症；其患病率在青春期后痤疮中高于青春期痤疮。20至25岁之间开始的痤疮被归类为“早发性成人痤疮”，并表现出不同的高雄激素血症特征。对每一位痤疮女性进行全面评估，无论年龄大小，包括进行激素分析和盆腔超声检查以检测激素失衡以便早期治疗，有助于预防和降低后果风险。
