The development and secretory activity of the skin’s sebaceous gland are unquestionably under hormonal pathogenesis and control and any means to manipulate this control could be of immediate importance in treatment. Skin’s androgens and adult acne are in a perpetual interplay as human skin is a collection of androgen-responsive tissues, hair follicles, sebaceous glands which secrete sebum, sweat glands, epidermis, dermis. Thus, acne vulgaris may be identified as intrinsically hormonal disorder even though, it may be manifestation of otherwise hormonal disease. Many practitioners and patients with acne believe that stress exacerbates the condition, delays the course of treatment of acne and clears the skin. Since adrenocoticotropic hormone (ACTH) is produced in response to stress, some researchers have focused on its possible role in the development of acne and seeking hormonal acne treatment. According to Toyoda et al there is ample clinical evidence suggesting that the nervous system such as emotional stress can influence the course of acne. Adrenal gland dysfunction and other comorbidities such as polycystic ovary syndrome may be present in some patients with acne, particularly when there is associated hirsutism, abnormal menses and infertility. Androgen serum levels are normal in most adult patients with acne suggesting that hypersensitivity of androgen receptors in pilosebaceous duct may be associated with development of adult acne. Although, according to Carmina et al serum androsterone glucuronide (AoG) is a metabolite of circulating androgens under the influence of 5alpha-reductase activity and has been shown to be particularly elevated in adult women with acne. Their study suggests that serum AoG is a sensitive marker of acne in women.
Recognition of role of hormones in acne and involvement of hormones especially androgens in development of acne suggests use of anti androgens in hormonal acne treatment and to clear skin from acne. However this approach sounds logical, normal serum androgens in most acne patients undermine the hypothesis. Hypersensitivity of androgen receptors in follicular ducts is an alternative way to explain the role of androgens in adult acne. Hormonal therapies provide valuable alternatives to standard hormonal acne treatment in selected individuals when there is evidence of hyperandrogenism.