In some women, acne can be associated with high levels of the hormone dehydroepiandrosterone sulfate (DHEAS), dihydrotestosterone (DHT), testosterone  or cortisol  and in men with high levels of cortisol [18,19], androstenedione, DHEAS [10,19] or estradiol . Other common symptoms in women with high levels of androgen hormones include excessive hair growth on the skin (hirsutism), hair loss on the scalp (alopecia) and abnormal menstruation.
Causes of Hormonal Acne
Conditions with increased levels of androgen and other hormones that can cause acne :
- Obesity associated with insulin resistance and therefore increased blood levels of insulin; it is not clear if untreated diabetes type 2 is associated with acne, though 
- Acromegaly with increased levels of the growth hormone (GH), insulin-like growth factor (IGF-1)  and testosterone 
- Congenital adrenal hyperplasia (CAH) with increased secretion of androgen hormones in children or adults 
- Cushing syndrome, for example, due to adrenal gland tumors with increased secretion of cortisol and androgen hormones [3,13,16]
- Polycystic ovary syndrome (PCOS) with increased levels of dehydroepiandrosterone sulfate (DHEA-S) 
- Pituitary adenoma with increased secretion of adrenocorticotropic hormone (ACTH) 
- Androgen-secreting tumors (in the ovaries or adrenal glands) in women 
- Hypothyroidism associated with an increased secretion of the hormone prolactin  and testosterone 
- High blood levels of free testosterone due to low levels of sex hormone binding globulin (SHBG) caused by progestin-containing contraceptives, including pills and intrauterine devices or IUDS (desogestrel, levonorgestrel, norethindrone, norgestimate, norgestrel), glucocorticoids, insulin or obesity 
Steroid acne develop as a side effect of steroid drugs :
- Oral steroids, such as prednisone
- Steroid creams
- Contraceptives: medroxyprogesterone injection, implanted or intrauterine progesterone and oral contraceptives which reduce circulating sex hormone binding globulin (SHBG)
- Dehydroepiandrosterone (DHEA)
- Anabolic steroids (danazol, stanozolol, nandrolone) used mainly by bodybuilders
Treatment of Hormonal and Steroid Acne
Antiandrogens such as cyproterone acetate , spironolactone , finasteride, flutamide  and corticosteroids (prednisone, dexamethasone) in low doses are used in women with signs of increased androgen production, such as excessive body hair; they may need 3-6 months to show effects [1,2,21].
- According to one 2012 review, spironolactone may help reduce hormone-related acne that appears in women before menstrual period .
- There is INSUFFICIENT EVIDENCE of the effectiveness of finasteride  and spironolactone [5,6] in reducing acne in women with diseases with increased androgen hormone levels.
- Prednisone by mouth can help in severe acne (acne fulminans) .
Side effects, such as breast tenderness, stomach upset and severe liver damage, limit the usability of antiandrogens in the treatment of acne in women . Antiandrogens are not convenient for the treatment of acne in men, because of feminizing side effects, such as impotence and enlarged breasts .
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- Chen MJ et al, 2011, High serum dehydroepiandrosterone sulfate is associated with phenotypic acne and a reduced risk of abdominal obesity in women with polycystic ovary syndrome PubMed
- Kim GK et al, 2012, Oral Spironolactone in Post-teenage Female Patients with Acne Vulgaris
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