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article on cycstic acne - New England Journal of Medicine

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Androgen excess in cystic acne

This is a really interesting article. It basically says that women and men with cystic acne have higher levels of testosterone in their blood.

"To lower dehydroepiandrosterone sulfate, dexamethasone was given to men, and dexamethasone or an oral contraceptive pill, Demulen (or both), was given to women. Of the patients treated for six months, 97 per cent of the women and 81 per cent of the men had resolution or marked improvement in their acne."

i'm a medical student so this makes sense to me, but if you're not this is what that translates to:

dehydroepiandrosterone sulfate is a testosterone that your adrenals make. when your pituitary sends a signal to your adrenals they make things like testosterone and cortisol (the stress hormone). dexamethasone is cortisone. when you take cortisone in a pill, this tells your pituitary that there is enough cortisone, so it stops telling your adrenals to make testosterone and cortisone. thus, your testosterone levels fall.

other ways to make testosterone levels fall is to take spirolactone (an anti-testosterone) and for women to take birth control pills with estrogen in them (the ratio of estrogen:testosterone is very important in your body too).

If your doctor has not evaluated your free testosterone levels in your blood, print this article and ask them to order a blood test. Especiallly if you are female, do not soley rely on your derm to treat your cystic acne. go to your gynecologist (who is better versed in horomones).

I'm not trying to second-guess anyone's doctor here (hey, i'm not even one yet) but make yourself an informed patient. We do know what causes cystic acne...(since 1983 when this was published!!!)

As the NEJM says:

"We conclude that most patients with therapeutically resistant cystic acne have androgen excess and that lowering elevated dehydroepiandrosterone sulfate results in improvement or remission of acne in most instances. "

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well..Why have many women complained of their acne returning, and returning worse, once they get off the pill?

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well..Why have many women complained of their acne returning, and returning worse, once they get off the pill?

the treatment they suggest isn't a one-time treatment. it needs to be continued for life: the androgen excess will return if you remove the exogenous hormones (ie the pill).

in other words, the pill provides estrogen which offsets the excess testosterone. when you get off the pill you remove the protective effect of the estrogen.

i'm not sure about acne returning worse (coincidental perhaps...or rumor? -- i've certainly never heard of this before). but certainly going off the pill would lead to a return of acne if you went on the pill to control acne in the first place.

i have a feeling the "acne returning worse than pre-pill" rumors are on par with the "the pill made me fat" rumors. unsubstantiated.

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Androgen excess in cystic acne

This is a really interesting article. It basically says that women and men with cystic acne have higher levels of testosterone in their blood.

"To lower dehydroepiandrosterone sulfate, dexamethasone was given to men, and dexamethasone or an oral contraceptive pill, Demulen (or both), was given to women. Of the patients treated for six months, 97 per cent of the women and 81 per cent of the men had resolution or marked improvement in their acne."

i'm a medical student so this makes sense to me, but if you're not this is what that translates to:

dehydroepiandrosterone sulfate is a testosterone that your adrenals make. when your pituitary sends a signal to your adrenals they make things like testosterone and cortisol (the stress hormone). dexamethasone is cortisone. when you take cortisone in a pill, this tells your pituitary that there is enough cortisone, so it stops telling your adrenals to make testosterone and cortisone. thus, your testosterone levels fall.

other ways to make testosterone levels fall is to take spirolactone (an anti-testosterone) and for women to take birth control pills with estrogen in them (the ratio of estrogen:testosterone is very important in your body too).

If your doctor has not evaluated your free testosterone levels in your blood, print this article and ask them to order a blood test. Especiallly if you are female, do not soley rely on your derm to treat your cystic acne. go to your gynecologist (who is better versed in horomones).

I'm not trying to second-guess anyone's doctor here (hey, i'm not even one yet) but make yourself an informed patient. We do know what causes cystic acne...(since 1983 when this was published!!!)

As the NEJM says:

"We conclude that most patients with therapeutically resistant cystic acne have androgen excess and that lowering elevated dehydroepiandrosterone sulfate results in improvement or remission of acne in most instances. "

Thanks for posting that! I have always felt that my hormones were the culprit of my resistant chin cysts, but the pill is off limits to me since I have a strong family hx of breast cancer. BUT my dermatologist just started me on spironolactone, and from what I've read here and on this site, I"m feeling more and more hopeful that I will finally hit the "source" of my cysts!!

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well..Why have many women complained of their acne returning, and returning worse, once they get off the pill?

the treatment they suggest isn't a one-time treatment. it needs to be continued for life: the androgen excess will return if you remove the exogenous hormones (ie the pill).

in other words, the pill provides estrogen which offsets the excess testosterone. when you get off the pill you remove the protective effect of the estrogen.

i'm not sure about acne returning worse (coincidental perhaps...or rumor? -- i've certainly never heard of this before). but certainly going off the pill would lead to a return of acne if you went on the pill to control acne in the first place.

i have a feeling the "acne returning worse than pre-pill" rumors are on par with the "the pill made me fat" rumors. unsubstantiated.

I'm 50 years old and have taken antibiotics for over 8 years for my cystic acne. I've been waiting for my "change of life" to see if my acne would finally stop then. Would they put a 50 year old on the pill?

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well..Why have many women complained of their acne returning, and returning worse, once they get off the pill?

the treatment they suggest isn't a one-time treatment. it needs to be continued for life: the androgen excess will return if you remove the exogenous hormones (ie the pill).

in other words, the pill provides estrogen which offsets the excess testosterone. when you get off the pill you remove the protective effect of the estrogen.

i'm not sure about acne returning worse (coincidental perhaps...or rumor? -- i've certainly never heard of this before). but certainly going off the pill would lead to a return of acne if you went on the pill to control acne in the first place.

i have a feeling the "acne returning worse than pre-pill" rumors are on par with the "the pill made me fat" rumors. unsubstantiated.

I'm 50 years old and have taken antibiotics for over 8 years for my cystic acne. I've been waiting for my "change of life" to see if my acne would finally stop then. Would they put a 50 year old on the pill?

you need to go to a gynecologist and ask him/her about this. I don't know why not though - many women dont go through menopause until they're 55.

have the antibiotics worked? generally, the definition of cystic acne is cystic infections. A cyst is a walled off infection. Antibiotics can't get through the walls of the cyts. Usually, antibiotics are innefective against cystic acne. I'd be curious to know if they've been working.

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Wait wait wait, you're a medical student and this is new information to you?

Uhhh...

Maybe I can be a doctor afterall. :lol: I didn't even go to college yet and even I have made this connection. It's all very obviously hormonal, because Androgens and Testosterone increased your sebacious glands activity, thus creating more oil, and excess oil is almost always the culprit. I don't know anyone who has acne but doesn't have oily skin, but I'm told some peolpe here do...All I can assume is that they have some other form of acne or something that isn't acne at all. *Shrug*

But then again, you're the med student. ;)

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Wait wait wait, you're a medical student and this is new information to you?

Uhhh...

Maybe I can be a doctor afterall. :lol: I didn't even go to college yet and even I have made this connection. It's all very obviously hormonal, because Androgens and Testosterone increased your sebacious glands activity, thus creating more oil, and excess oil is almost always the culprit. I don't know anyone who has acne but doesn't have oily skin, but I'm told some peolpe here do...All I can assume is that they have some other form of acne or something that isn't acne at all. *Shrug*

But then again, you're the med student. ;)

no it wasn't news to me, but i figured it would be news to some people on this board. you know, the people who are posting things like "constipation causes acne" and "do you eat fast food?", etc.

there is a lot of misinformation about acne, especially cystic acne.

to every rule there is an exception. i'm sure that of all the cystic acne sufferers there are a few that do not have oily skin. i personally did not start getting cystic acne until last year...when my skin was much less oily than it was when i was 16 (and on accutane the first time).

but really, oily skin is a side effect, not a cause. the cause is excess androgens. by the way, androgen = testosterone. it is androgen(s) plural b/c there are several different types of testosterone.

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I not sure if it is safe to take all these pills targeted specifically for controlling hormones in women. But I found loads of interesting information on http://www.acne-wise.com/sebum.htm on different ways to balance testosterone and reduce sebum production.

Extracts:

Diet

Testosterone is converted to a more potent form called dihydrotestosterone (DHT) by an enzyme called 5 alpha reductase. Acne patients show an increase activity of this enzyme resulting in more potent androgens to cause more oil production and clogging of pores. By maintaining a higher intake of protein in relation to carbohydrates you reduce the activity of 5 alpha reductase and thus the formation of the more potent DHT. Avoid consuming carbohydrates which total more than 60 to 70% of your diet and keep your protein intake about 40 to 45%.

Agents

Ketoconazole is currently used as an anti-fungal agent in the treatment of fungal infections. Ketaconazole is also known to have antiandrogenic effects and can cause a reduction in the production of testosterone and other androgens by the adrenal gland and by the male and female reproductive organs. A good idea is to purchase Nizoral shampoo which contains 2% Ketoconazole. (KETOCONAZOLE IS FOUND IN HEAD & SHOULDERS).

Oral

Spironolactone is an anti-androgen antibiotic that has a direct effect on the sebaceous gland reducing sebum production and comedone formation. It is generally prescribed for females.

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I know this may be a bit personal, but does masturbation play an effect on testosterone levels?

I dont know much on masturbation and acne, if there is a connection at all, but i feel as though when i masturbate much less (once a week and not consistently) a cyst pops up. Is there more built up testosterone? I can almost feel myslef being a lot more aggressive in my actions also? When i masturbate more or at a consistent amount, my acne seems to be non existant and I dont seem to act as aggressive.

I know, wierd thing to mention but i think it might be relevant. :angel:

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This study is just one of many that simply added androgen imbalance to the long, long list of potential acne causes. Remember, correlation doesn't necessarily mean causality. Granted, it'd have to have been a well-controlled and analyzed study to be pubbed in NEJM, but still, the point remains: This doesn't mean hormone levels are causing YOUR cystic acne.

Question everything...even the NEJM.

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:angel: Am I reading correctly...that article in the NEJM is from 1983??? Don't get me wrong, it's great info and all and I truly believe that hormones have alot to do with acne, but wow, that's old by most research standards. Just my opinion. Great info though, thanks. :angel:

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:angel: Am I reading correctly...that article in the NEJM is from 1983??? Don't get me wrong, it's great info and all and I truly believe that hormones have alot to do with acne, but wow, that's old by most research standards. Just my opinion. Great info though, thanks. :angel:

um, well i did mention that in my post. so yes, i am aware that it is old news. apparently not to a lot of people on this board though.

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I'm on the pill & it has not helped my skin at all....Yasmin is supposed to be low hormones though, so maybe that's why.

I still feel like my breakouts are hormonal though....I dont have health insurance, so its a problem to go back to the gyno and get my prescription changed when I've already gone this year.

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hi, i'm new here. i've got pretty big pimples, not sure if they can be classified as cystic tho'.

anyway, i'm just very curious in what way is a cystic pimple different from a normal pimple, apart fromt the size and the obvious inflammation.

i mean, is it such because the 'head' of the pimple is deeper beneath the skin? what is so different about the anatomy of a cystic pimple that makes it so different?

any takers?

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That's right. I went off the pill(ortho-tri cyclen) about a month ago after taking them for 6 years and my acne is back!!!! :( I was willing to stay on the pill for rest of my life just for a clear skin. But it is a sacrifice I have to make for a baby. Why can't there be a permanent solution to this? I'm going back to pill once I finish my mission!

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Man Ive read every theory under the sun and tried nearly every treatment based on one of those theories. If the theory breeds a workable cure then the theory is probably true. Try the facemaster course for a practical theory.

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answer me this:

i got a free testoterone reading, and it said my levels were normal.

why do i have cystic acne?

before I got my results... my gyno put me on both YAZ and 200mg of spironolactone. do you think with these 2 drugs, and normal hormonal levels... my acne may be made less severe?

and stress is the cause of this?

if I do something to lessen the stress in my life. think that will help?????????

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