isotretinoin and Hyperandrogenism

Acne vulgaris is a common disorder that affects more than 17 million individuals in the United States. Knowledge of the disease is an important part of clinical practice, particularly for the pediatric practitioner. Contrary to common belief, acne is not a disease limited to adolescents and young adults but can occur at any stage of life. This article is a case-based review of acne during childhood and adolescence. Workup is based on age and concurrent physical findings, whereas therapy depends on the type of skin lesions along with patient characteristics and preferences.

Topics: Acne Vulgaris; Adolescent; Child; Dermatologic Agents; Diagnosis, Differential; Female; Humans; Hyperandrogenism; Infant, Newborn; Isotretinoin; Male

Topics: Acne Vulgaris; Administration, Oral; Adult; Anti-Bacterial Agents; Female; Folliculitis; Humans; Hyperandrogenism; Isotretinoin; Keratolytic Agents; Male; Pyoderma; Sex Factors

There are some side effects of isotretinoin in many organs. However, a study investigating the effects of isotretinoin on the human ovarian reserve has not been reported previously. The study was conducted to investigate possible effects of isotretinoin on ovarian reserve. Serum anti-Müllerian hormone (AMH) levels were measured at the beginning and at the end of isotretinoin treatment in 22 patients with acne and in 22 women without. The mean AMH level before treatment was 5.77 ng/mL in the study group and 3.79 ng/mL in the control group (p = 0.008). Following treatment, the mean AMH level was 4.69 ng/mL in the study group. This mean AMH level after treatment was statistically lower than the AMH level before treatment (p = 0.012). There was no significant difference between the mean AMH level at the end of treatment and that of the control group (p = 0.20). The high level of pre-treatment AMH levels could be an evidence of hyperandrogenism in women with acne, even if they are not identified as having polycystic ovary syndrome (PCOS) or hyperandrogenism. Decrease in AMH levels following exposure to isotretinoin may suggest that it has a detrimental effect on the ovaries.

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Mullerian Hormone; Cell Count; Dermatologic Agents; Female; Humans; Hyperandrogenism; Isotretinoin; Oocytes; Ovary; Young Adult

Many patients who were diagnosed as polycystic ovary syndrome- (PCOS-) related acne were not capable of sustaining or beginning oral contraceptive pills (OCPs) due to pill scaring, contraindications of OCP use, migraine, or smoking. In this situation, oral isotretinoin treatment may become an important option for PCOS-related acne. The aim of the study was to determine the effects of isotretinoin treatment on PCOS patients who were complicated with severe cystic acne.. This study consisted of 40 female patients diagnosed as PCOS complicated with severe cystic acne. These patients were not eligible candidates for OCP use due to migraine, thrombophilia, heavy smoking, or pill scare. To establish baseline values of hormone levels, on days 2-5 of the menstrual cycle, venous blood samples were obtained. Moreover Modified Ferriman-Gallwey (mFG) score, acne score (AS), follicle count, and bilateral ovarian volumes were evaluated both before and after isotretinoin treatment.. Isotretinoin treatment significantly decreased Ferriman-Gallwey score, free testosterone, insulin level, hemoglobin level, acne score, and ovarian volume. Increased triglyceride and cholesterol levels were detected after treatment.. Isotretinoin treatment may have beneficial effects on free testosterone, insulin, acne score, and Ferriman-Gallwey score. Solely isotretinoin administration may supply adequate healing in PCOS patients' symptoms complicated with severe cystic acne who is not eligible candidates for OCP use. This trial is registered with Clinicaltrials.gov NCT02855138.

Topics: Acne Vulgaris; Adolescent; Adult; Contraceptives, Oral, Combined; Female; Humans; Hyperandrogenism; Insulin; Isotretinoin; Menstrual Cycle; Polycystic Ovary Syndrome; Prospective Studies; Testosterone; Young Adult

Topics: Acanthosis Nigricans; Acne Vulgaris; Adult; Dermatologic Agents; Female; Humans; Hyperandrogenism; Insulin Resistance; Isotretinoin; Pyoderma Gangrenosum; Syndrome

Treatment failures with isotretinoin in female patients are frequently related to endocrinological dysfunctions. Such a concept has never been discussed in male patients.. An extensive endocrinological work-up has been performed in nine male patients who presented with an acne refractory to conventional treatment and to isotretinoin. Adrenal dysfunction was found in four patients and isolated 5-alpha reductase hyperactivity in 2 cases. Three work-ups were normal. A suppressive treatment in three patients with adrenal dysfunction provided immediate efficacy.. These results would provide insight into the mechanism of refractory acne in men.

Topics: Acne Vulgaris; Adolescent; Adult; Androgens; Diagnosis, Differential; Drug Resistance; Female; Humans; Hyperandrogenism; Isotretinoin; Male; Treatment Failure

Topics: Acne Vulgaris; Drug Resistance; Female; Humans; Hyperandrogenism; Isotretinoin; Keratolytic Agents

We earlier demonstrated that oral isotretinoin can be associated with hyperandrogenism in women with acne. The aim of this study was to evaluate the causal relationships of the different etiologies in case of unsuccessful treatment.. The study group included 120 patients with late-onset acne resistant to different treatment and signs of hyperandrogenism. A complete hormone work-up was obtained in all patients. There was a group of 23 patients who failed to respond to isotretinoin and 97 patients in the control group. Unsuccessful treatment was defined as persistance of grade 2 lesions after a mean cumulative dose of 166 mg/kg isotretinoin.. In the non-responders to isotretinoin, hyperandrogenism was observed in 22 out of 23 cases: pituitary (n = 2), adrenal (n = 5), ovarian (n = 13), peripheral (n = 2). In the control group, hyperandrogenism was found in 89 out of 97 patients: pituitary (n = 6), adrenal (n = 45), ovarian (n = 33), peripheral (n = 5). The distribution of two etiologies, ovary and adrenal, demonstrated a significant difference between isotretinoin non-responders and controls, the former having a higher frequency of ovarian hyperandrogenism.. These findings confirm that untreated hyperandrogenism, particularly ovarian hyperandrogenism, is a source of unsuccessful treatment with oral isotretinoin.

Topics: Acne Vulgaris; Adolescent; Adult; Drug Resistance; Female; Humans; Hyperandrogenism; Isotretinoin; Keratolytic Agents; Middle Aged; Treatment Failure