Both clinical observation and experimental evidence confirm the importance of hormones in the pathophysiology of acne. Hormones are best known for their effects on sebum excretion. It has also been suggested that hormones may play a role in the follicular hyperkeratinization seen in follicles affected by acne [1-3]. From a therapeutic standpoint, the importance of the role of hormones in acne is supported by the clinical efficacy of hormonal therapy in women with acne.
Although we know that hormones are important in the development of acne, many questions remain unanswered about the mechanism by which hormones exert their effects. For example, the specific hormones that are important in acne have not been definitively identified. Androgens such as dihydrotestosterone (DHT) and testosterone (T), the adrenal precursor dehydroepiandrosterone sulfate (DHEAS), estrogens such as estradiol and other hormones such as growth hormone may each be important in acne. It is not known if these hormones are taken up from the serum by the sebaceous gland or if they are made locally within the gland. Finally, the cellular and molecular mechanisms by which these hormones exert their influence on the sebaceous gland have not been fully elucidated. The goal of this chapter is to present the clinical and experimental evidence for the role of hormones in acne while pointing out gaps in our current understanding. As future research fills in these gaps, we will be able to design improved therapies that target the hormonal causes of acne.
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