Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF
Letter to the Editor
2013:79:3;422-424
doi: 10.4103/0378-6323.110772
PMID: 23619449

Hormonal profile and polycystic ovaries in women with acne vulgaris

Zubair Abdullah1 , Qazi Masood1 , Iffat Hassan1 , Omar Kirmani2
1 Department of Dermatology, STD and Leprosy, GMC, Srinagar, Jammu and Kashmir, India
2 Department of Radiology, GMC Srinagar, Jammu and Kashmir, India

Correspondence Address:
Zubair Abdullah
Room No. 413, Surgeons Hostel Opposite Emergency Section SMHS Hospital Srinagar, Jammu and Kashmir
India
How to cite this article:
Abdullah Z, Masood Q, Hassan I, Kirmani O. Hormonal profile and polycystic ovaries in women with acne vulgaris. Indian J Dermatol Venereol Leprol 2013;79:422-424
Copyright: (C)2013 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

Polycystic ovarian syndrome (PCOS) has since its description by Stein and Leventhal in 1935, become one of the commonest disorders in women affecting 5-10% in the reproductive age group. [1],[2] The disorder manifests as hirsutism, obesity, menstrual disturbances, acne vulgaris, male pattern baldness, recurrent abortion, infertility, anovulation, psychosocial, and psychosexual morbidity. [3] Acne vulgaris is a self-limiting disease that affects the sebaceous follicles. It is a multifactorial disorder. Some important pathogenic factors involved include hyperkeratinization and obstruction of the sebaceous follicles as a result of abnormal keratinization of the infundibular epithelium, androgenic stimulation of sebaceous glands, and microbial colonization of pilosebaceous units by Propionibacterium acnes and subsequent perifollicular inflammation. [4]

Previous studies have shown that androgenic hormonal balance may be disturbed to some degree in about 50-75% of female-acne patients. [5] PCOS is the most frequent hormonal disease associated with acne and this can be detected by ultrasonography and measurement of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and serum testosterone levels in these patients. Most of these patients have no other clinical features of the syndrome that consists of hirsutism, infertility, or irregular menstruation. This study was performed to assess the hormonal abnormalities and polycystic ovaries (PCO) in women with acne vulgaris of ethnic Kashmiri origin.

One hundred fifty female patients of Kashmiri ethnic origin in the age group of 16-35 years with acne vulgaris were included in the study. Patients with hirsutism, menstrual abnormalities, history of intake of oral contraceptive pills, and body mass index of >25.0 were excluded from the study. Control group consisted of 150 age-matched female patients who attended out-patient department for some unrelated disorder. The study was approved by the ethical committee of the hospital. Each patient and control received a detailed clinical examination and underwent a relevant laboratory evaluation. Acne vulgaris in cases was graded using William J Cunliffe grading system into four grades. [6] Blood samples for hormonal assessment were obtained in the follicular phase. Levels of LH, FSH, total testosterone, prolactin, and androstenedione were determined. All hormonal measurements were carried out using ELISA kit (Monobind Inc., USA; and Equipar Diagnostica, Italy). Transabdominal ultrasonography was performed in follicular phase by a radiologist using Siemens Sonoline Adara with 3.5-Hz convex electronic probe. The diagnosis of polycystic ovaries was made if 10 or more follicles each 2-8 mm diameter were present in the ovarian periphery and stoma was echodense [Figure - 1]. Statistical package for the social sciences, version 10.0 was used for analysis of data. Correlation was performed using Pearson′s test. Categorical variables were compared by using Chi-square test and for continuous variables t-test was used for comparing two groups. Two-tailed significance was calculated and P0 < 0.05 was considered significant.

In 60% of cases, age of onset of acne was between 16 to 19 years. Grade 1 acne was present in 17.5%, grade 2 in 46.0%, grade 3 in 33.5%, and grade 4 in 3%. Hormonal abnormalities were found in 36% of patients as compared to 9% in controls. Polycystic ovaries on ultrasonography were found in 28.8% of cases as compared to 9.3% in controls. A statistically significant difference (P=0.000) was found between the two groups. Sixty-seven percent of patients with hormonal abnormalities had polycystic ovaries on ultrasonography. No statistically significant difference in the mean serum levels of FSH (p =0.264) and prolactin (p =0.679) was found between the two groups. The mean serum levels of LH (p = 0.001), testosterone (0.000), and androstenedione ( p = 0.000) were significantly greater in cases as compared with the controls [Table - 1]. No statistically significant difference was found in the hormonal abnormalities and ultrasonographic evidence of polycystic ovaries between various grades of acne.

Figure 1: Ultrasonography (USG) showing polycystic ovaries
Table 1: Comparison of various parameters between cases and controls

In this study, 36% of acne females had at least one abnormal (greater than the upper limit) biochemical marker of PCOS, that is raised serum LH, raised LH/FSH ratio, or raised testosterone. Serum FSH and serum prolactin levels were normal in both patients and controls, with LH, testosterone, and androstenedione having significantly higher mean levels in acne patients than controls. [7] Vexiau, et al. [8] has reported hyperandrogenism in 86% of patients with persistent acne without signs of virilism. Slayden, et al. [9] reported abnormal levels of androgenic markers in 76% and 55% of patients with adult onset acne, respectively. As our population was not confined to persistent acne or adult onset acne, hormonal abnormalities were found in 36% of patients.

In conclusion, this study demonstrates a higher evidence of polycystic ovaries and androgenic hormone abnormalities in females with acne compared with females without acne. Moreover, polycystic ovaries are common in women with acne and not necessarily associated with menstrual disorders, obesity, or hirsutism and that these patients can be considered as a part of the clinical spectrum of fully developed PCOS.

References
1.
Stein LF, Leventhal MC. Amenorrhea associated with bilateral polycystic ovaries. Am J Obstet Gynecol 1935;29:181-91.
[Google Scholar]
2.
Franks S. Polycystic ovary syndrome. N Eng J Med 1995;333:853-61.
[Google Scholar]
3.
Tsilchorozidou T, Overton C, Conway GS. The pathophysiology of polycystic ovary syndrome. Clin Endocrinol (Oxf) 2004;60:1-17.
[Google Scholar]
4.
Toyoda M, Morohashi M. New aspects in acne inflammation. Dermatology 2003;206:17-23.
[Google Scholar]
5.
Sheehan-Dare RA, Hughes BR, Cunliffe WJ. Clinical markers of androgenicity in acne vulgaris. Br J Dermatol 1988;119:723-30.
[Google Scholar]
6.
Cunliffe WJ, Gollnick HP. Acne: Diagnosis and management. J R Soc Med 2001;94:652.
[Google Scholar]
7.
Förström L, Mustakallio KK, Dessypris A, Uggeldahl PE, Adlercreutz H. Plasma testosterone levels and acne. Acta Derm Venereol 1974;54:369-71.
[Google Scholar]
8.
Vexiau P, Husson C, Chivot M, Brerault JL, Fiet J, Julien R, et al. Androgen excess in women with acne alone compared with women with acne and/or hirsutism. J Invest Dermatol 1990;94:279-83.
[Google Scholar]
9.
Slayden SM, Moran C, Sams WM Jr, Boots LR, Azziz R. Hyperandrogenemia in patients presenting with acne. Fertil Steril 2001;75:889-92.
[Google Scholar]

Fulltext Views
164

PDF downloads
37
Show Sections