HORMONAL ASSESSMENT IN ACNE VULGARIS IN WOMEN

Abstract

BACKGROUND Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit characterised clinically by non-inflammatory lesions, open and closed comedones and papules or pustules and nodules of varying degree of inflammation and depth, distributed predominantly over face, back and chest. There are various aetiopathogenetic mechanisms and the major pathogenic factors involved are hyperkeratinisation, obstruction of sebaceous follicle resulting from abnormal keratinisation of the infundibular epithelium, stimulation of sebaceous gland secretion by androgens and various hormones and microbial colonisation of pilosebaceous units by P. acnes which promotes perifollicular inflammation. Of note, hormonal therapies are indicated in severe, resistant-to-treatment cases and in those with monthly flare-ups and when standard therapeutic options are inappropriate. So based on grading of acne and duration of lesions and time of presentation, hormonal assessment plays an important role in the management of acne vulgaris. MATERIALS AND METHODS Hormonal evaluation is not mandatory for those who experience short bouts of onset and offset or those who respond well to standard treatments. However, in the more resistant cases and for those who fail to respond to conventional therapies and based on the grading endocrinal evaluation along with investigations-lipid profile, thyroid profile and ultrasound abdomen are important tools in the management of acne vulgaris. However, in our study, 25 female patients aged between 16 -35 years who failed to respond to novel conventional treatments of acne were selected and subjected to hormonal assessment. Study Design-This is a descriptive study by assessing various hormonal levels in selected patients. Study Setting-DVL Department, Andhra Medical College affiliated to King George Hospital, Visakhapatnam, Andhra Pradesh, India. RESULTS Out of 25 patients, 12 patients (48%) were in the age group between 15 - 20 years with moderate degree of acne with PCOS, 8 patients (32%) were in the age group between 21 - 25 years, 3 patients (12%) were in the age group between 26 -30 years and 8% were between 31 -35 years, and in our study out of 25 patients 56% had hypertriglyceridaemia, 20% with increased free testosterone levels and very few patients with obesity and features of virilisation. CONCLUSION Thus, Hormonal evaluation should not be the last option in treating acne vulgaris and is mandatory not only for more resistant acne cases and for those who fail to respond to conventional therapies, but it also should be done in the beginning even in mild degrees of acne to prevent acne scarring.