Treatment for Androgen acne
For most people, acne begins at puberty. The body starts to produce hormones called androgen’s. Androgen’s cause the enlargement and over-stimulation of the sebaceous glands in people with acne. This leads to the over-production of sebum, and coupled with a sluggish exfoliation process leads to blocked pores and acne. Sensitivity to these androgen’s also causes acne during the menstrual cycle and sometimes in pregnancy or during the menopause.
Androgen acne Treatment
Spironolactone: This compound is a synthetic steroid, which decreases sebum secretion by 30 to 50%. It blocks the androgen receptor and inhibits the enzyme 5 alpha reductase in the skin. Recommended doses are 50 – 100mg. Healthy women and women with inflammatory acne lesions respond and tolerate well to a 25mg. dose. Breast tenderness, menstrual irregularities, testicular atrophy and erectile dysfunction are some of the side effects. Pregnancy during spironolactone therapy should be avoided. Spironolactone may induce high potassium levels. While it is mostly used orally, some studies have looked at its use topically, though not enough to make a conclusion on how effective it might be topically for acne.
Flutamide: It is the oldest antiandrogen with potent non-steroidal antiandrogenic actions. However it also has the most adverse side effects. It is administered orally in doses of 250mg daily in combination with an oral contraceptive. Liver function tests should be monitored during treatment since it can cause hepatitis. Being an antiandrogen it can be teratogenic, i.e. cause birth defect in children conceived by women on this drug during pregnancy. Hence the risk – benefit ratio should be well assessed prior to use of this drug in women. Flutamide has therefore been largely replaced by bicalutamide, a newer drug in this class with less serious side effccts.
Premature menopause: Testosterone replacement should also be considered part of the management of young women with premature menopause, particularly those with Turner’s syndrome (45,XO). In general, women who undergo menopause in their reproductive prime suffer considerably from symptoms related to androgen deficiency, particularly diminished libido. Alternatively, young women with premature menopause who have not previously been sexually active should be made fully aware of the availability of androgen replacement and, in some instances, offered low dose androgen therapy as part of their hormone replacement.
Premenopausal women: It is not uncommon for premenopausal women to complain of diminished libido, and, when other potential influences on sexual dysfunction can be excluded and they have low levels of bioavailable testosterone, androgen replacement therapy is likely to be beneficial.
Antiandrogens have been found to be effective in the treatment of acne androgen and hirsutism. Cyproterone acetate has been used in Europe for many years, but in the United States it has only been approved as an orphan drug to treat severe hirsutism. Spironolactone is approved in the United States for its antialdosterone effect but not for its antiandrogenic effect, although it is widely used for the latter purpose. While cyproterone is a more effective drug than spironolactone, it is more likely to produce undesirable side effects.
Additionally, acne research scientists are working on other forms of acne treatment. For example, researchers are studying the biology of sebaceous cells and testing a laser in laboratory animals to treat acne by disrupting the sebaceous glands. Scientists are also studying the treatment of androgenic disorders — including acne — in men by inhibiting an enzyme that changes testosterone to a more potent androgen.
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