[Acne, hyperandrogenism and oral isotretinoin resistance. 23 cases. Therapeutic implications].

BACKGROUND

We earlier demonstrated that oral isotretinoin can be associated with hyperandrogenism in women with acne. The aim of this study was to evaluate the causal relationships of the different etiologies in case of unsuccessful treatment.

PATIENTS AND METHODS

The study group included 120 patients with late-onset acne resistant to different treatment and signs of hyperandrogenism. A complete hormone work-up was obtained in all patients. There was a group of 23 patients who failed to respond to isotretinoin and 97 patients in the control group. Unsuccessful treatment was defined as persistance of grade 2 lesions after a mean cumulative dose of 166 mg/kg isotretinoin.

RESULTS

In the non-responders to isotretinoin, hyperandrogenism was observed in 22 out of 23 cases: pituitary (n = 2), adrenal (n = 5), ovarian (n = 13), peripheral (n = 2). In the control group, hyperandrogenism was found in 89 out of 97 patients: pituitary (n = 6), adrenal (n = 45), ovarian (n = 33), peripheral (n = 5). The distribution of two etiologies, ovary and adrenal, demonstrated a significant difference between isotretinoin non-responders and controls, the former having a higher frequency of ovarian hyperandrogenism.

DISCUSSION

These findings confirm that untreated hyperandrogenism, particularly ovarian hyperandrogenism, is a source of unsuccessful treatment with oral isotretinoin.