From the Guidelines
Androgen excess plays a significant role in the development of acne vulgaris in adolescents, as it stimulates oil glands, leading to increased sebum production, which is a primary contributor to acne development. The pathogenesis of acne is multifactorial, involving follicular hyperkeratinization, microbial colonization with Cutibacterium acnes, sebum production, complex inflammatory mechanisms, and genetic and nongenetic factors 1.
Key factors that contribute to acne development in adolescents include:
- Increased sebum production due to hormonal changes during puberty, particularly androgens
- Bacterial colonization, especially by Cutibacterium acnes
- Follicular hyperkeratinization
- Inflammation resulting from the immune response to bacteria and irritants
- Genetic factors influencing susceptibility to acne
When treating acne in adolescents, it is essential to consider these factors and develop a comprehensive approach that may include:
- Topical treatments, such as benzoyl peroxide, retinoids, and antibiotics
- Systemic medications for severe cases, including oral antibiotics, isotretinoin, and hormonal therapy for females
- Lifestyle modifications addressing diet, stress management, and proper skincare
According to the guidelines of care for the management of acne vulgaris, spironolactone, an aldosterone receptor antagonist that decreases testosterone production, is conditionally recommended for acne treatment based on moderate certainty evidence 1. Additionally, oral isotretinoin is strongly recommended for severe acne, acne causing psychosocial burden or scarring, or acne failing standard treatment with oral or topical therapy 1.
In terms of management, the guidelines recommend a multimodal therapy approach, combining multiple mechanisms of action, and limiting systemic antibiotic use to reduce the development of antibiotic resistance and other antibiotic-associated complications 1.
Overall, a comprehensive treatment plan that addresses the underlying causes of acne, including androgen excess, and incorporates a combination of topical and systemic therapies, as well as lifestyle modifications, is essential for effective management of acne vulgaris in adolescents.
From the Research
Role of Androgen Excess in Acne Vulgaris
- Androgen excess is a key factor in the development of acne vulgaris, particularly in adolescents 2.
- The exact mechanism by which androgen excess contributes to acne is not fully understood, but it is thought to involve increased sebum production and follicular hyperkeratinization 3, 4.
- Hormonal therapies, such as combination oral contraception or spironolactone, are often used to treat acne in females with androgen excess 2.
Treatment Options for Acne Vulgaris
- Topical therapies, such as retinoids and benzoyl peroxide, are first-line treatments for mild to moderate acne 3, 4, 5, 2.
- Oral antibiotics, such as doxycycline and minocycline, are often used in combination with topical therapies to treat more severe acne 2, 6.
- Isotretinoin is a highly effective treatment for severe acne, but it is often reserved for cases that are resistant to other treatments due to its potential side effects 3, 2, 6.
Management of Severe Acne Vulgaris
- Severe acne vulgaris can be effectively managed with a combination of topical and oral therapies 4, 6.
- Fixed-combination topical therapies, such as adapalene and benzoyl peroxide, have been shown to be effective in reducing inflammatory lesions and preventing scarring 4, 5, 6.
- Oral doxycycline has been shown to be a safe and effective treatment option for severe inflammatory acne, particularly when used in combination with topical therapies 6.