In some women acne can be persistent, resistant to treatment and with premenstrual flare-ups. In others it can be of late onset. In these types of acne, hormones – in particular androgens, may have important role. These hormones increase the size and secretion of sebaceous glands. Sebum along with dead keratinocytes obstruct the follicular duct forming a plug, which enlarges to become a closed comedone (white head) and consequently an open comedone (black head). This may be more increased in women with this type of acne.
In most of them the serum androgen levels are normal. Few of them may show signs of hyperandrogenism such as hirsutism, alopecia and irregular menses.. In females, androgens (such as testosterone and dehydroepiandrosterone) are secreted in small amounts by the ovary and adrenal glands. One of the most common cause of hyperandrogenism in females is polycystic ovary syndrome (PCOS). If this is suspected, measurement of serum androgen levels and ultrasonography of the pelvic region is necessary.
In women with acne and clinical signs of hyperandrogenism, and in whom other modalities of treatments have failed, an antiandrogen hormonal therapy may be required. This consists in use of androgen receptor blockers or specified oral contraceptives. Hormonal therapy for acne should be taken under strict supervision of a dermatologist.
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