Cosmetic in Japan 美容医学への扉-東京大学美容外科-アンチエイジング
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Web Master -Kotaro Yoshimura, M.D.-

Influence of Androgen on Acne.

Kotaro Yoshimura

It is known that androgen influences adolescent acne well. Androgen promotes production of Triglycerides (50% of the sebum) and it is assumed that they become nutrients for Propionibacterium acne. When adrenal maturity is noted before menarche, and comedo is seen at that time, significant elevation of DHEAS (dehydroepiandrosterone sulfate) is seen. There is a great deal of androgen-dependent secretion in neonates, but it decreases afterward. It begins to increase from puberty again, and decreases after peaking between 18-20 years of age. In women, sebum secretion tends to decrease after menopause, but does not change very much in men until they reach their 70s.

Androgen level decrease with age makes cellular turnover of the sebaceous gland slow, and induces hyperplasia of the sebaceous gland. Ultraviolet rays and immunologic inhibition (immunosuppressive agents and steroids) seem to induce hyperplasia of the sebaceous gland too.

In brief, the metabolism of DHEA produced in the adrenal glands is related to the following enzymes:

  Androstenedione ⇔ testosterone → DHT
          17β-HSD      5α-reductase

It has been reported that 5α-reductase, 17β-hydroxysteroid dehydrogenase (HSD) is high within the keratinocytes of the folliculus pili aperture, especially in acne patients. It remains unclear, however, whether this is a cause or result of acne. In addition, it has been reported that a local conversion enzyme did not show any difference in normal patients compared to that of acne patients. A male-female difference was seen, with it higher in men than women. DHEAS, Androstenedine, T, freeT, and DHT in serum were found to be significantly higher in women with acne compared to those without. In men, a significant difference was not seen between normal men and those with acne.

In another report, hypertrichosis was seen in 21% of the female acne patients, and either one of T, androstendione, DHEA, DHEA-S, or SHBG showed a value beyond the normal range. In addition, polycystic ovary (PCO) was recognized in 50%, menoxenia in 48%.

On the other hand, in the examined male acne patients, a significant increase in blood LH , T, and androstendione was seen, while E2, DHEA-S, 17α -hydroxyprogesterone, and 11-deoxyCortizol weren't changed significantly. Male LH decreases with age, but it is assumed that it is slow in the acne patient.

For females with acne, there are many reports of therapeutic use of contraceptives. For example, T from adrenals, oophoron, and periphery tissue origin decreased when ethinyl estradiol was administered, including a small amount of progesterone. On the other hand, T derived from adrenals and periphery tissue decreased when ethinyl estradiol was administered including a large amount of progesterone. Both reduced free T to a similar degree, but SHBG was reduced more by ethinyl estradiol with large amounts of progesterone. In other words, contraceptives with low progesterone content reduced total T more. Clinically, it is assumed that both were effective on acne to the same degree.

Acne treatment by birth control pill is comparatively safe, and an effect can be expected in some cases, but it seems necessary to determine its effectiveness in Japanese people in the future, because there is very little data now. In addition, there is a risk of aggravating acne in some cases because there is some androgen action in the progesterones of the pills. Thus, a trial treatment with dominant use of oestradiol was done. It is necessary to use carefully for influence on the endometrium, but an effect can be expected, more so than with other treatments.

Estrogen shows anti-androgen action in two ways: 1) increased SHBG in blood 2) reduced secretion of gonadotrophin by the pituitary gland and GnRH by the hypothalamus. Estrogen treatment may not have only anti-androgen action, but direct action on the skin as well. However, there are a great many points that remain unclear about such action, and will be gradually clarified by future study.

In addition, there are various approaches in anti-androgen treatment (cf. other documents). It is recommended that antinuclear antibody or IgE be measured, in addition to various hormone values, by blood examination. Hormonal data such as total testosterone, DHEA LH, and FSH should be measured because they are useful for diagnosis of PCO