Acne, Hormonal with Hirsutism
Definition: Hormonal acne with Hirsutism is a subtype of acne often linked with androgen excess. Androgens increase sebum production and follicular keratosis, which are key factors in the development of acne. Hirsutism is defined as the excessive growth of terminal hair in women in a pattern typically seen in men.
Epidemiology: This condition frequently affects women from their late teens into adulthood and is often linked to polycystic ovary syndrome (PCOS).
Signs: Along with typical acne lesions (comedones, papules, pustules), patients may show signs of hirsutism, such as excessive facial and body hair, and other indications of hyperandrogenism like alopecia and irregular menstruation.
Symptoms: Patients may experience symptoms of acne, such as inflammation and tenderness, along with hirsutism. These issues can lead to psychological distress, driven by cosmetic concerns and social stigma.
Differentials: Other types of hyperandrogenic disorders such as congenital adrenal hyperplasia, androgen-secreting tumours, and other types of acne.
Diagnosis: A comprehensive history and targeted physical examination are crucial for evaluating androgen excess in the clinic. This includes a clinical assessment of acne and hirsutism, supported by laboratory tests to measure androgen levels, and imaging studies to evaluate ovarian morphology if PCOS is suspected.
Treatment: Treatment for acne includes topical anti-acne agents, oral antibiotics like tetracycline, antiandrogens (such as hormone therapy and birth control pills), and oral isotretinoin. Management of hirsutism typically involves a dual approach: pharmacological therapy to reduce androgen secretion and/or action, and the removal of existing terminal hair.
References: (AMA)
- Lumezi BG, Pupovci HL, Berisha VL, Goçi AU, Gerqari A. Acne in hirsute women. Postepy Dermatol Alergol. 2014;31(6):356-361. doi:10.5114/pdia.2014.47118
- Yildiz BO. Diagnosis of hyperandrogenism: clinical criteria. Best Practice & Research Clinical Endocrinology & Metabolism. 2006;20(2):167-176. doi:https://doi.org/10.1016/j.beem.2006.02.004
- Tewary S, Davies R, Prakash A. Hirsutism. Obstetrics, Gynaecology & Reproductive Medicine. Published online March 12, 2021. doi:https://doi.org/10.1016/j.ogrm.2021.02.004