Best Acne Treatment To Get Rid Of Acne And Acne Scar:What Is The Cause of Hirsutism and Acne in Women?

Best Acne Treatment To Get Rid Of Acne And Acne Scar:What Is The Cause of Hirsutism and Acne in Women?
Last month in Clinical Chemistry, Fiet et al. described
a method for the simultaneous measurement of eight
steroids in women with hirsutism and acne (1). The
method is simple and provides analytically specific results.
Importantly, the authors tested the approach clinically,
with encouraging results. The clinical evaluation
of patients with androgen-related disorders is often
challenging and new approaches are welcomed.
An assumption driving measurements of multiple steroids
in patients with hirsutism and acne is that these
conditions are androgen-related disorders, having as a
common denominator an increase in ovarian or adrenal
androgen production. Although it is important to rule
out significant abnormalities in ovarian and adrenal
secretion in patients complaining of such disorders, the
tenet that these skin manifestations of androgen excess
solely signi1r increased ovarian or adrenal androgen
production is no longer valid.
The effects of androgen on the skin may be dissociated
from other effects of androgen such as that on the hypothalamic-
pituitaiy-ovarian axis (2). Thus, a woman
who has hyperandrogenemia need not have hirsutism or
acne: Witness the woman with polycystic ovary syndrome
who is not hirsute (3, 4). On the other hand,
many women with hirsutism or acne may have normal
ovarian and adrenal androgen production. In this setting,
enhanced activity of skin 5a-reductase appears to
explain much of the abnormality, and specific markers
of this activity in blood have been suggested as useful (3,
5-7).
Apart from these general considerations, practical
clinical concerns must also be contemplated in advocating
the measurement of multiple steroids. Ruling out
the extremely rare patient with an adrenal tumor may
be important, but a detailed assessment of adrenal androgen
production to determine adrenal enzymatic activity
may be unnecessary unless the concern of the
patient is pregnancy. For the complaint of hirsutism,
adrenal suppression with dexamethasone is not highly
effective; using antiandrogen therapy without corticosteroids
provides greater efficacy (8, 9). Thus, even in
the setting of enhanced androgen production, blockade
of androgen action may be more efficacious.
Nevertheless, the comprehensive data by Fiet et al.
are noteworthy in that a simplified method of analysis
with small volumes of sera has been described. Utilization
of the SPA methodolor greatly affects the efficiency
of the assay. A potential concern, that a particular
steroid may coelute into adjacent fractions, does not
appear to be significant: The assays are highly specific
and the reported recoveries appear to be good. The requirement
of only small volumes (<1>