madman
Super Moderator
* Androgens contribute to acne through increased sebum production, abnormal desquamation/comedone formation, and inflammation.
Dr Lawrence Green discusses how androgens and DHT contribute to acne pathogenesis through sebum production, inflammation, and abnormal keratinization. Learn when to incorporate hormonal therapies like spironolactone and clascoterone, why serum androgen levels may not correlate with acne severity, and how anti-androgen strategies offer a more comprehensive, mechanism-based approach to acne management.
Acne and Androgen Signaling: Expanding the Role of Anti-Androgen Therapy
Dr Lawrence Green discusses how androgens and DHT contribute to acne pathogenesis through sebum production, inflammation, and abnormal keratinization. Learn when to incorporate hormonal therapies like spironolactone and clascoterone, why serum androgen levels may not correlate with acne severity, and how anti-androgen strategies offer a more comprehensive, mechanism-based approach to acne management.
Clinical Summary
Acne and Androgen Signaling: Expanding the Role of Anti-Androgen Therapy
- Acne, androgens, and DHT-related pathways: Androgens contribute to acne through increased sebum production, abnormal desquamation/comedone formation, and inflammation. Serum androgen levels have not consistently correlated with acne severity, although one small study suggested the androgen-to-estrogen ratio may be associated with acne burden.
- Clascoterone (FDA-approved topical antiandrogen): Approved for acne in men and women; used particularly for oily skin and hormonally driven acne, especially in female patients. Dr Green uses clascoterone in addition to standard acne therapies rather than as a replacement for benzoyl peroxide or other anti-inflammatory treatments.
- Spironolactone and mechanism-based treatment: Spironolactone is commonly used in women with inflammatory acne, including menstrual-related and non-menstrual acne, and may perform similarly to doxycycline in some studies. Hormonal therapies target multiple pathogenic factors—sebum production, keratinization, and inflammation—more comprehensively than many current acne treatments.
