HormonalTreatmentofAcneinWomen.PDFVIP

[ D e c e m b e r 2 0 0 9 ? V o l u m e 2 ? N u m b e r 1 2 ]16 [ L I T E R A T U R E R E V I E W ] ABSTRACT Acne vulgaris is a common and chronic disorder of the pilosebaceous unit. Standard treatment protocols include topical retinoids, topical and oral antimicrobials, and isotretinoin. Hormonal therapies can be added to the regimen in some patients. This article will review the hormonal pathogenesis of acne, discuss the basics of an endocrine evaluation, and provide an overview of the current hormonal treatment options in women. (J Clin Aesthetic Dermatol. 2009;2(12):16–22.) Acne vulgaris is a common disorder of thepilosebaceous unit. Its mean prevalence inadolescents is estimated to be 70 to 87 percent.1 Initially miscategorized as an adolescent disorder, acne studies reveal that the mean age of presentation for treatment is 24 years, with 10 percent of visits occurring when patients are between the ages of 35 and 44 years.2,3 Genetics and gender are important factors in the prevalence of acne. One study of 200 patients with post- adolescent acne found that 50 percent of patients reported at least one first-degree family relative with acne.4 In regard to gender, acne is significantly higher among women than men in all age groups.3 These findings have led to a new initiative urging dermatologists to take the lead in educating fellow clinicians on the chronicity of acne.5 By recognizing acne as a chronic disease similar to eczema, early and aggressive treatment can be started to avoid the psychological sequela that can result from active disease and scars.5 The direct cost of acne in the United States is estimated to exceed $1 billion per year, with $100 million spent on over-the-counter products.2 Despite this high cost, 81 percent of women report failures with systemic antibiotics, and failures with isotretinoin range from 15 to 30 percent.6 This article will focus on the advanced treatments for acne using hormonal regulation. It will review the hormona