Hormonal and metabolic aspects of acne vulgaris in women with polycystic ovary syndrome

Eur Rev Med Pharmacol Sci. 2018 Jul;22(14):4411-4418. doi: 10.26355/eurrev_201807_15491.


Objective: Acne vulgaris in women can indicate a systemic disease, such as polycystic ovary syndrome (PCOS), which is associated with hormonal and metabolic disorders. The aim of this study was to investigate the influence of hormonal and metabolic disorders on acne vulgaris in women with PCOS.

Patients and methods: The study included 110 women with PCOS. Women were divided according to their androstenedione concentration: within reference range (n=66) or higher (n=44). All patients were between 17-36 years old. Acne was graded according to the US FDA scale for a five-category global system (acne global severity scale). Hirsutism was defined using a modified Ferriman-Gallwey method. Fasting plasma glucose, insulin, luteinizing hormone, follicle-stimulating hormone, 17α-hydroxyprogesterone, 17-beta-estradiol, sex hormone-binding globulin and androgen (androstenedione, total testosterone, free testosterone, dehydroepiandrosterone sulfate) were assessed, as were prolactin and cortisol concentrations. Thyrotropin and free thyroxine concentrations were also measured. The free androgen index (FAI) and homeostatic model assessment-insulin resistance (HOMA-IR) index were calculated.

Results: The average age and rating on the hirsutism scale were similar in both analyzed groups. A higher percentage of severe acne was observed in the group of women with an androstenedione concentration within reference range than in the group with the higher concentration. Meanwhile, the severity of acne in the group of PCOS women with the higher androstenedione concentration was correlated with higher concentrations of total testosterone, free testosterone, dehydroepiandrosterone sulfate, and cortisol. Increased glucose concentration was also proportional to the severity of acne. We did not observe a statistically significant correlation between the severity of acne and the androstenedione concentration. In the group of PCOS women as a whole, the severity of acne was correlated only with higher dehydroepiandrosterone sulfate concentration; other androgens did not affect the severity.

Conclusions: The acne global severity scale in PCOS women is associated with higher concentrations of total testosterone, free testosterone, dehydroepiandrosterone sulfate, and FAI value. Higher concentrations of androstenedione did not affect acne severity.

Publication types

  • Observational Study

MeSH terms

  • Acne Vulgaris / diagnosis*
  • Acne Vulgaris / etiology
  • Acne Vulgaris / metabolism
  • Adolescent
  • Adult
  • Androgens / blood
  • Androgens / metabolism
  • Dehydroepiandrosterone Sulfate / blood
  • Dehydroepiandrosterone Sulfate / metabolism
  • Female
  • Humans
  • Polycystic Ovary Syndrome / blood
  • Polycystic Ovary Syndrome / complications*
  • Polycystic Ovary Syndrome / metabolism
  • Severity of Illness Index
  • Testosterone / blood
  • Testosterone / metabolism
  • Young Adult


  • Androgens
  • Testosterone
  • Dehydroepiandrosterone Sulfate