Serum levels of androgens in acne & their role in acne severity

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Objectives: To correlate acne severity with elevated androgen levels and to compare androgen levels between cases and controls.

Methods: This case-control study was carried out in the Department of Dermatology, Mayo Hospital, Lahore from March 2016 – March 2017. Two hundred and seventy patients and eighty age and gender matched controls were recruited after ethical approval and informed consent and categorized into mild, moderate and severe acne. Severity was correlated with serum Testosterone, Dihydrotestoststerone and Dihydroepiandrosterone Sulphate levels. Quantitative variables were expressed as median and percentiles, comparisons done by Mann-Whitney and correlations by Spearman correlation. P-value of <0.05 was considered statistically significant.

Results: There were 142 (41%) males and 208 (59%) females. Ninety-Seven patients had mild, 108 moderate and 65 had severe disease. Median hormonal levels were 3.5ng/ml, 184pg/ml and 0.82ug/dl for Testosterone, Dihydrotestosterone and Dihydroepiandrosterone Sulphate respectively which differed significantly between cases and controls. There was no correlation with severity but the levels differed significantly between the different grades in case of Testosterone and DHEAS.

Conclusion: Androgens are not directly correlated with acne severity, but affect acne severity as seen in difference between their levels in different grades of acne. Anti-androgens may be initiated early in acne resistant to conventional therapy.


Although androgenic hormones may be raised in the acne patients as compared to controls, only Testosterone and DHEA-S levels serve as markers of acne severity. Any therapy targeted towards acne and its severity can, therefore, be directed towards the ovarian androgen production, or blocking of androgen receptors in the pilosebaceous unit. Thus hormonal therapy can be an adjuvant to early treatment in acne.