Role of androgens in female-pattern androgenetic alopecia, either alone or associated with other symptoms of hyperandrogenism.

The roles of androgen hypersecretion, in situ enzyme activity, and androgen receptors in androgenetic alopecia in women are still a matter of debate. We studied 187 women with alopecia, which we graded I, II, or III, according to Ludwig's classification, and 21 healthy control women. All participants were subjected to full basal and 1 h post-beta-1-24 corticotropin stimulation endocrine profiles. Abnormal hormone profiles were observed in 67% of the patients with alopecia alone (group A, n = 110) and in 84% of the patients with alopecia plus other symptoms of hyperandrogenism including acne, hirsutism, and menstrual cycle disturbances (group B, n = 77). Mean serum 5alpha-androstane-3alpha,17beta-diol glucuronide (3alpha-AdiolG) levels in all three patient groups (6.50+/-4.10, 8.90+/-5.80, and 14.70+/-8.90 nmol/l, respectively) correlated with the grade of alopecia (I-III) and were significantly higher than in the control group (4.80+/-2.05 nmol/l, P < 0.005). Mean serum sex hormone-binding globulin (SHBG) levels were inversely correlated with the grade of alopecia (I-III) and were significantly lower in all three patient groups (50.55+/-23.50, 40.00+/-17.65, and 38.80+/-14.10 nmol/l, respectively) than in the control group (61.15+/-17.65 nmol/l, P < 0.05). Mean serum levels of delta4-androstenedione, dehydroepiandrosterone, dehydroepiandrosterone sulfate, and 3alpha-AdiolG were higher in group B than in group A, and higher in group A than in the control group. The significant correlations found between adrenal secretion - either positive (with 3alpha-AdiolG levels and the body mass index) or negative (with SHBG levels) - might reflect the important contribution of secretory and metabolic components in the development of alopecia, the severity of which has been shown to be very closely related to observed levels of two of these parameters (3alpha-AdiolG and SHBG).

[Aggravation of acne by isotretinoin. 6 cases, predictive factors]. / Aggravation de l'acné sous isotrétinoïne. 6 cas, facteurs prédictifs.

OBJECTIVE: Acne flare-ups are frequent in the early phase of isotretinoin treatment. Severity varies from one patient to another. Clinical factors favoring a potentially severe course were assessed on the basis of 6 cases. CASE REPORTS: Six male patients, mean age 16.5 years, with inflammatory acne with a major retentional component were studied. Isotretinoin administered at a daily dose 0.5 mg/kg led to explosive development of massive nodulocystic lesions or pyogenic granulomas within two months. The lesions healed at withdrawal of isotretinoin and administration of antibiotics and antiinflammatory drugs. There was important scar sequellae. DISCUSSION: Four concomitant factors were identified which contribute to the development of acne flare-ups: sex (male), young age, retentional form of acne and daily isotretinoin dose 0.5 mg/kg.

[Acne, hyperandrogenism and oral isotretinoin resistance. 23 cases. Therapeutic implications]. / Acné, hyperandrogénie et résistance à l'isotrétinoïne orale. 23 cas. Implications thérapeutiques.

BACKGROUND: We earlier demonstrated that oral isotretinoin can be associated with hyperandrogenism in women with acne. The aim of this study was to evaluate the causal relationships of the different etiologies in case of unsuccessful treatment. PATIENTS AND METHODS: The study group included 120 patients with late-onset acne resistant to different treatment and signs of hyperandrogenism. A complete hormone work-up was obtained in all patients. There was a group of 23 patients who failed to respond to isotretinoin and 97 patients in the control group. Unsuccessful treatment was defined as persistance of grade 2 lesions after a mean cumulative dose of 166 mg/kg isotretinoin. RESULTS: In the non-responders to isotretinoin, hyperandrogenism was observed in 22 out of 23 cases: pituitary (n = 2), adrenal (n = 5), ovarian (n = 13), peripheral (n = 2). In the control group, hyperandrogenism was found in 89 out of 97 patients: pituitary (n = 6), adrenal (n = 45), ovarian (n = 33), peripheral (n = 5). The distribution of two etiologies, ovary and adrenal, demonstrated a significant difference between isotretinoin non-responders and controls, the former having a higher frequency of ovarian hyperandrogenism. DISCUSSION: These findings confirm that untreated hyperandrogenism, particularly ovarian hyperandrogenism, is a source of unsuccessful treatment with oral isotretinoin.

[Acne in adult women: data from a national study on the relationship between type of acne and markers of clinical hyperandrogenism]. / Acné de la femme adulte.

INTRODUCTION: The role of hyperandrogenism in acne occurring or persisting in adult women is controversial. Studies reported have often been carried out in hospital settings. The aim of this nationwide prospective and descriptive study was to evaluate the frequency of clinical hyperandrogenism in a large number of adult acneic women visiting dermatologists in a non-hospital setting. PATIENTS AND METHODS: Three hundred and fifteen dermatologists completed clinical questionnaires concerning the next five female patients with acne at their private practices. These patients had to be between 25 and 45 years of age. The questionnaire covered patients' demographic characteristics, medical history, gynaecological status and acne history. Patients' acne, seborrhea and cycle disorders were described, as well as other signs suggesting hyperandrogenism, such as hirsutism and alopecia. RESULTS: A total of 1 135 questionnaires were analyzed. Nearly 50 p. 100 of the patients had major scalp or facial seborrhea, 18.4 p. 100 hirsutism, 7 p. 100 alopecia and 32.2 p. 100 menstrual cycle abnormalities. When these signs were present, acne was more often retentional, with more scarring and more widespread. CONCLUSION: This prospective study in a large number of patients in a non-hospital setting shows that acne in adult women is frequently associated with clinical hyperandrogenism.

[Acne in the male resistant to isotretinoin and responsibility of androgens: 9 cases, therapeutic implications]. / Acné de l'homme résistant à l'isotrétinoïne et responsabilité des androgènes: 9 cas, implications thérapeutiques.

INTRODUCTION: Treatment failures with isotretinoin in female patients are frequently related to endocrinological dysfunctions. Such a concept has never been discussed in male patients. CASE REPORTS: An extensive endocrinological work-up has been performed in nine male patients who presented with an acne refractory to conventional treatment and to isotretinoin. Adrenal dysfunction was found in four patients and isolated 5-alpha reductase hyperactivity in 2 cases. Three work-ups were normal. A suppressive treatment in three patients with adrenal dysfunction provided immediate efficacy. COMMENTS: These results would provide insight into the mechanism of refractory acne in men.

Effects of minoxidil 2% vs. cyproterone acetate treatment on female androgenetic alopecia: a controlled, 12-month randomized trial.

BACKGROUND: Hormone studies have demonstrated the androgen-dependent character of female androgenetic alopecia, but there have been few controlled studies of therapies for alopecia in women. OBJECTIVES: To compare topical minoxidil 2% and cyproterone acetate in the treatment of female alopecia. METHODS: Sixty-six women with female-pattern alopecia were randomly assigned for 12 cycles into two groups, 33 received two local applications (2 mL day-1) of topical minoxidil 2% plus combined oral contraceptive and 33 received cyproterone acetate 52 mg day-1 plus ethinyl oestradiol 35 microg for 20 of every 28 days. RESULTS: A mean reduction of 2.4 +/- 6.2 per 0.36 cm2 in hairs of diameter > 40 microm was observed in the cyproterone acetate group (P = 0.05) and a mean increase of 6.5 +/- 9 per 0.36 cm2 in the minoxidil group (P < 0.001). Comparison of the total number of hairs at 12 months and the body mass index (BMI) revealed a borderline positive correlation in the cyproterone acetate group (r = 0.39, P = 0.06) and a negative correlation in the minoxidil group (r = -0.42, P < 0.05). No significant difference was observed in the total number of hairs among cyproterone acetate patients according to the presence or absence of other symptoms of hyperandrogenism, whereas in the minoxidil group, the total number of new hairs was higher in patients with isolated alopecia (Delta = 8.1; P < 0.05). Variations in scalp seborrhoea were significant in both groups, but the result was better (for acne and hirsutism as well) in the cyproterone acetate group than in the minoxidil group (P < 0.001). CONCLUSIONS: Minoxidil treatment was more effective in the absence of other signs of hyperandrogenism, hyperseborrhoea, and menstrual cycle modifications when the BMI was low, and when nothing argued in favour of biochemical hyperandrogenism. Cyproterone acetate treatment was more effective when other signs were present and when the BMI was elevated, factors that favoured a diagnosis of biochemical hyperandrogenism.