When to suspect underlying hormonal pathology for acne?

A Hormonal evaluation is reserved for those patients who experience the following:

1 ) Therapy-resistant acne, especially those who fail to respond to isotretinoin therapy or relapse shortly after discontinuing isotretinoin.

2) Those who develop late-onset (adult acne, after 35 years of age), or sudden-onset, or severe, unresponsive, and persistent acne.

3) Prepubertal acne.

4) History of premenstrual flare.

5) Associated signs of hyperandrogenism, such as hirsutism, deeping of voice, androgenetic alopecia.

6) Females with history suggestive of poltcystic ovarian syndrome(PCOS) like menstrual irregularities, infertility, weight gain and insulin resistance.

7) HAIR-AN syndrome (hyperandrogenism , insulin resistance, and acanthosis nigricans)

8) Associated with cutaneous signs of hyperinsulininemia, such as acanthosis nigricans, skin tags, mid-truncal obesity, etc.

Clinical Picture which warrants hormonal evaluation: The concentration of lesions along the jawline and chin. It has been seen that more than 50% of adult female patients of persistent acne have at least one abnormal hormonal level. Acne associated with obesity, hirustism, hairfall, acanthosis etc.

Investgations required while suspecting hormonal disturbance in a female patient.

1) Testosterone.

2) Free Androgen Index.

3) DHT.

4) LH.

5) Prolactin.

6) 17-OH-Progesterone.

7) Estrogen.

8) Fasting and postprandial insulin.

9) Ultrasonography of pelvis.

Acne is one of the common clinical feature besides obesity, insulin resistance, hirsutism etc in these females. So hormonal acne is treated accordingly.