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Feily A, Taheri T, Meier-Schiesser B, et al. The effect of low-dose isotretinoin therapy on serum androgen levels in women with acne vulgaris. Int J Womens Dermatol. 2019;6(2):102-104doi: 10.1016/j.ijwd.2019.10.007.
Feily, A., Taheri, T., Meier-Schiesser, B., Rhinehart, D. P., Sobhanian, S., Colon-Diaz, M., Feily, A., & Ramirez-Fort, M. K. (2020). The effect of low-dose isotretinoin therapy on serum androgen levels in women with acne vulgaris. International journal of women's dermatology, 6(2), 102-104. https://doi.org/10.1016/j.ijwd.2019.10.007
Feily, Amir, et al. "The effect of low-dose isotretinoin therapy on serum androgen levels in women with acne vulgaris." International journal of women's dermatology vol. 6,2 (2020): 102-104. doi: https://doi.org/10.1016/j.ijwd.2019.10.007
Feily A, Taheri T, Meier-Schiesser B, Rhinehart DP, Sobhanian S, Colon-Diaz M, Feily A, Ramirez-Fort MK. The effect of low-dose isotretinoin therapy on serum androgen levels in women with acne vulgaris. Int J Womens Dermatol. 2019 Nov 14;6(2):102-104. doi: 10.1016/j.ijwd.2019.10.007. eCollection 2020 Mar. PMID: 32258342; PMCID: PMC7105656.
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Int J Womens Dermatol. 2019 Nov 14;6(2):102-104. doi: 10.1016/j.ijwd.2019.10.007. eCollection 2020 Mar.

The effect of low-dose isotretinoin therapy on serum androgen levels in women with acne vulgaris.

International journal of women's dermatology

Amir Feily, Tahere Taheri, Barbara Meier-Schiesser, Dena P Rhinehart, Saeed Sobhanian, Maricarmen Colon-Diaz, Ahmad Feily, Marigdalia K Ramirez-Fort

Affiliations

  1. Dermatology, Jahrom University of Medical Sciences, Jahrom, Iran.
  2. Student Research Committee, Jahrom University of Medical Sciences, Jahrom, Iran.
  3. Dermatology, Zurich University Hospital, Zurich, Switzerland.
  4. Radiation Oncology, Medical University of South Carolina, Charleston, SC, United States.
  5. Department of Health, Jahrom University of Medical Sciences, Jahrom, Iran.
  6. Physiology and Pathology, San Juan Bautista School of Medicine, Caguas, Puerto Rico.
  7. Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran.
  8. Urology, Weill Cornell Medicine College, New York, NY, United States.

PMID: 32258342 PMCID: PMC7105656 DOI: 10.1016/j.ijwd.2019.10.007

Abstract

BACKGROUND: Acne vulgaris is a common dermatologic disease that causes significant social and psychological morbidity. Isotretinoin, as a vitamin A derivative, is the most effective agent in the treatment of acne. Evidence suggests that isotretinoin's therapeutic function is independent of hormonal mediation; however, the effect of isotretinoin on serum androgens and precursor androgen levels in humans remains unclear.

OBJECTIVE: Herein, we aim to investigate the effect of low-dose isotretinoin on androgen levels in women and postulate the role of concomitant anti-androgen therapy (e.g., spironolactone).

METHODS: A total of 36 women, age 18 to 30 years, with moderate-to-severe nodulocystic acne were treated with 20 mg isotretinoin (Roaccutane) daily for 3 months. A hormone panel was obtained at baseline and after completion of the treatment course. The panel included dehydroepiandrosterone (DHEA), 17-hydroxyprogestrone, testosterone, free testosterone, dihydrotestosterone (DHT), luteinizing hormone, follicle stimulating hormone, and prolactin.

RESULTS: Serum levels of testosterone (p = .015), prolactin (p = .001), and DHT (p = .001) were significantly decreased, while serum levels of DHEA (p = .001) significantly increased after isotretinoin treatment. No significant change was found in the other hormones evaluated.

LIMITATIONS: The distribution of acne was not assessed in our patient population. We did not directly evaluate for associations between elevated DHEA levels and clinical response rates.

CONCLUSION: Isotretinoin alone can decrease androgen levels, but increase an important driver of acne pathogenesis (i.e., DHEA). The co-administration of an anti-androgenic agent (e.g., spironolactone) may optimize the therapeutic efficacy of isotretinoin by limiting iatrogenic increases in DHEA and perhaps allow for more widespread use of low-dose isotretinoin.

© 2019 Published by Elsevier Inc. on behalf of Women's Dermatologic Society.

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