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Acne Vulgaris in Adult Females: Hormonal treatment

  • Hormonal therapies (antiandrogens) such as oral contraceptives and spironolactone are often used in the treatment of acne, particularly in adult women.
  • It is therefore sometimes useful to run blood tests in acne patients entering this category, morevover when there is a clinical suspicion of virilizing ovarian tumors, polycystic ovarian syndrome (PCOS), congenital adrenal hyperplasia (CAH). Recalcitrant/ persistant cases of acne in adult women should also be tested.

The algorythm goes as follows:
 test for Dehydroepiandrosterone (DHEA), LH/FSH ratio and testosterone
  • if levels are normal: treat for acne in a stepwise fashion
  • if the testosterone level elevated
  1. highly elevated: suspect ovarian tumor. Refer to gynaecologist, and then treat with antiandrogens
  2. mildly increased or if LH/FSH ratio higher than 2:3: suspect PCOS. Refer to gynaecologist and then treat with antiandrogens
  3. with increased DHEA: suspect CAH. Test for 17-hydroxyprogesterone and refer to endocrinologist. Then treat with antiandrognes


This advice is for informational purposes  only and does not replace therapeutic judgement done by a skin doctor.

Source of information: here