Factors in the etiopathogenesis of post-adolescent female acne

Abstract

Background and Design: Post-adolescent acne has been defined as acne that persists or whose onset starts beyond the age of 25 years. The presence of hyperandrogenemia, polycystic ovary syndrome (PCOS), dyslipidemia, and insulin sensitivity play a role in etiopathogenesis of post-adolescent acne in women as shown in previous studies. This study was conducted to investigate these relationships. Materials and Methods: We included 45 female patients with post-adolescent acne and 30 age, sex, and body mass index-matched healthy controls. Demographic characteristics, clinical signs of hyperandrogenemia, pelvic ultrasound scan, and hormonal assessment including the [total testosterone (TT), sex hormone binding globulin (SHBG), dehydroepiandrosterone sulfate (DHEAS), follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), estradiol (E2)] and fasting plasma glucose, and insulin and lipid levels were recorded. Results: Woman with post-adolescent acne had the marked presence of menstrual abnormalities (37.7%), hirsutism (13.3%), androgenetic alopecia (11.1%), metabolic syndrome (MS) (32.4%), and PCOS (22.2%). Pelvic ultrasound scans showed that 17.8% of the patients had polycystic ovaries. In addition, the percentage of current smokers was significantly higher in the patient group than the controls (p=0.001). TT and LH were significantly higher in post-adolescent acne patients than the controls (p=0.048, and p=0.012, respectively). No significant differences were observed between patients and controls in terms of SHBG, DHEAS, FSH, PRL, E2, and total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride levels. No correlations were observed between these parameters and the severity of acne. Conclusion: Although laboratory hormonal assessment showed no significant difference, post-adolescent acne patients had marked menstrual irregularities, polycystic ovaries, androgenetic alopecia, hirsutism, and MS. However, insulin resistance and dyslipidemia may not play a major role in the pathogenesis of post-adolescent female acne.