Increased Ratio of Androgen to Estrogen May Worsen Acne

The ratio of androgen to estrogen in patients with acne vulgaris is an independent risk factor for acne grade, according to findings from a study published in Clinical, Cosmetic and Investigational Dermatology.

Researchers obtained medical records from patients tested for sex hormones and a primary diagnosis of acne vulgaris from July 2021 through June 2022 at a hospital in Beijing, People’s Republic of China. Participants were categorized into 4 groups based on clinical diagnosis and Pillsbury acne grades I to IV and were further classified into subgroups of men and women for statistical analysis.

A total of 693 patients were included (81.5% women). Women had a mean age of 26.7±6.4 years, and men had a mean age of 24.0±6.7 years. Grade II acne was most prevalent in women (41.2%), and grade III acne was most prevalent in men (39.8%).

Serum follicle-stimulating hormone, estradiol, progesterone, testosterone, and the ratio of androgen to estrogen for the different acne grades were statistically significant in women with acne (P <.05), and no difference was found for luteinizing hormone and prolactin. Serum estradiol, testosterone, and the ratio of androgen to estrogen for different acne grades were found to be statistically significant in men with acne (P <.05), but follicle-stimulating hormone, luteinizing hormone, progesterone, and prolactin were not different based on acne grades.

Hormone levels of the men with acne were primarily within the normal reference range. Also, 2 of the 128 men had higher testosterone levels, and 4 (4.3%) of the 565 women had lower levels. Estradiol increased in 49 (8.7%) patients and decreased in 210 (37.2%) patients.

Spearman analyses of all influencing factors showed that acne grades of men and women with acne were negatively correlated with estradiol expression (P <.05) and positively correlated with testosterone and the ratio of androgen to estrogen (P <.05). Acne grades in women were negatively correlated with age and progesterone (P <.05) and positively associated with follicle-stimulating hormone (P <.05).

Multinomial logistic regression indicated to investigators that the ratio of androgen to estrogen was an independent risk factor for acne grade with acne worsening as the ratio of androgen to estrogen increased.

Study limitations include the cross-sectional design based on 1 dermatology hospital. Also, the secondary diagnosis of the patients’ body mass index, lifestyle habits, and genetic factors was not further analyzed, which resulted in selection bias.

“The ratio of androgen to estrogen has the potential to be an indicator of acne grades,” stated the study authors.