What is the role of androgen excess in the pathogenesis of acne vulgaris?

Updated: Mar 14, 2018
  • Author: Mohamed Yahya Abdel-Rahman, MD, MSc; Chief Editor: Richard Scott Lucidi, MD, FACOG  more...
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Acne vulgaris can be aggravated or initiated by increased androgen levels as the excess sebum production and the shedding of hyperkeratinized epithelium may occlude the hair follicle. Propionibacterium acnes proliferates and triglycerides of sebum are then hydrolyzed by the bacterial lipases to form glycerol and free fatty acids, which, together with other bacterial metabolites, cause inflammation. It is also commonly proposed that hypersensitivity of PSU to androgens is the cause of acne. [22] Sebum production increases markedly during the prepubertal period, a time when serum levels of DHEAS, a precursor to testosterone, are also elevated. Individuals who are insensitive to androgen have less active sebaceous glands and do not develop acne.

Although there has been some controversy over whether acne is common enough in androgen excess to be considered a sign of hyperandrogenemia, a study by Uysal et al indicated that it is indeed evidence of the condition. The study found that of 207 women aged 18-45 years suffering primarily from acne, 72% demonstrated clinical and/or biochemical hyperandrogenemia. [23]

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