CLINICAL REPORT Correlation between Endocrinological Parameters and Acne Severity in Adult Women Francesco BORGIA 1 , Salvatore CANNAVO ` 2 , Fabrizio GUARNERI 1 , Serafinella Patrizia CANNAVO ` 1 , Mario VACCARO 1 and Biagio GUARNERI 1 1 Institute of Dermatology and 2 Unit of Endocrinology, University of Messina, University Hospital ‘‘G. Martino’’, Messina, Italy Many studies demonstrate increased androgen levels and high prevalence of polycystic ovaries in women affected by acne. We evaluated the relationship between clinical features, ultrasonographic data on polycystic ovaries and hormonal parameters in 129 women w17 years of age with acne. Serum levels of androgens of ovarian and adrenal origin were measured. Menstrual cycle regular- ity, hirsutism, body mass index and ultrasonographic evaluation of ovaries were recorded. Raised levels of at least one androgen were evident in a majority of our patients. Only 19% of them had polycystic ovary syndrome. Hirsutism and acne severity correlated negatively with serum sex hormone-binding globulin (SHBG) levels ( pv0.05). No correlation between acne severity and hirsutism was found. In post-pubertal women, severity of acne seems to depend on peripheral hyperandrogenism, with a negative relationship between the acne severity and serum SHBG levels. We strongly recommend the evaluation of serum SHBG levels in women with acne in order to select patients who can have a better response to appropriate hormonal regimes. Key words: acne; polycystic ovary; ultrasound examination; sex hormone-binding globulin; sebocyte. (Accepted November 6, 2003.) Acta Derm Venereol 2004; 84: 201–204. Francesco Borgia, MD, Institute of Dermatology, University Hospital, Via Consolare Valeria Gazzi, IT-98125 Messina, Italy. E-mail: Ist.Dermatologia@unime.it Acne vulgaris, depending on definition, affects 20 – 90% of all adolescents, with spontaneous resolution, in most cases, in the late teens or early twenties (1). However, in a steadily increasing group of patients – especially women – community-based studies (2, 3) have shown that acne may persist into middle-age, so called acne tarda. Many hypotheses have been proposed to explain this trend, for example, oral contraceptives containing progestogens with strong anti-oestrogenic properties and inappropriate application of cosmetics, but the exact mechanism is still unknown. A recent study showed the importance of familial factors for the development of persistent facial acne, suggesting that genetic factors may influence the failure of acne-prone follicles to evolve into acne-resistant follicles in early adult life (4). It is well known that the function of the sebaceous glands is strongly influenced by biologically active androgens of ovarian and adrenal origin (5). The peripheral effects of androgens are mediated by their binding to nuclear androgen receptors. In the skin, the sebocyte plays a key role in the androgen homeostasis by synthesis or inactivation of testosterone and its biologically active metabolite, 5a-dihydrotestosterone (6). Acne is a common feature in the course of endocrine diseases, characterized by raised levels of androgens, and often responds positively to oral contraceptives, suggesting a striking pathogenetic role of hyperandro- genism. Further evidence is provided by the positive correlation between increased rate of sebum excretion, regulated by androgens, and degree of acne severity (7). However, although the involvement of androgens in the pathogenesis of acne is well established, it is still not exactly clear how the hormonal stimulation is related to the clinical expression and the course of the disease. We carried out an open study to evaluate the relationship between clinical features, hormonal para- meters of pituitary, adrenal and ovary function, and ultrasonographic data in a large group of women with acne. SUBJECTS AND METHODS We enrolled 129 women (mean age 24.0¡4.5 years; mean duration of the disease 5.9¡4.6 years) referred to our unit for acne in 1999 – 2000. None of the patients had used oral contraceptive treatment, anti-androgen therapy, systemic antibiotics or isotretinoin therapy during the previous 6 months. Informed consent was obtained after the modalities and aims of the study had been fully explained. The history of each patient was taken with particular regard to the presence of oligomenorrhoea. In accordance with literature, oligomenorrhoea was defined as a menstrual cycle longer than 35 days (8, 9). Weight and height were recorded to calculate body mass index (BMI). BMI scores between 19 and 25 were considered normal. The presence of hirsutism was scored in every woman by a single investigator, using the Ferriman-Gallwey index (Fi) (10, 11). Hirsutism was defined as a Fi score w8. All subjects were clinically evaluated by the same Acta Derm Venereol 2004; 84: 201–204 Acta Derm Venereol 84 # 2004 Taylor & Francis. ISSN 0001-5555 DOI: 10.1080/00015550410023248