| BackgroundIn present society, acne, a disfigurement disease, was payed more and more attention to. As a common, frequently-occurring disease, it causes physical and mental health problems in patients. With the pace of life speed and work stress increasing,the incidence of acne becomes higher than before.The age of onset in adolescent turns earlier. The incidence at the middle-aged women also increased significantly because of the cosmetics for external use and the gynecologic diseases such as polycystic ovary syndrome increasing. Acne occurs mainly on the face, therefore gives patients a great psychological burden,such as low self-esteem, poor self-esteem, depression, shyness and so on. Though it is not the number one disease to human health, acne can seriously endanger the status of patients'survival. At the confusing stage of drug selection in treatment of acne, this study, focus on changes in hormone levels of female patients and further analysis the causes of acne, in order to set up an effective measures to regulate the treatment.Objective1. To test the sexual hormones changes in female patients with acne and discuss the roles of sexual hormones changes,especially the androgen,in the pathogenesis of acne and its clinical significance .To study the relationship between the sexual hormone levels and the severity of acne in order to provide guidance for clinical treatment.2.To observe the efficacy and safety in female patients with acne after Proscar (Finasteride) therapy and discuss its mechanisms.3.To discuss the changes of sexual hormones after Proscar (Finasteride) therapy.Study Design and Methods1.The serum levels of luteinizing hormone(LH),follicle stimulating hormone(FSH), prolactin(PRL), estradiol(E2) ,testosterone (T) , dihydrotestosterone(DHT) ,free testosterone(FT) . estradiol (E2) and sex hormone - binding globulin(SHBG) were measured by the radio-immunity method in 76 female patients with acne and 24 normal individuals.2.40 female patients with acne were randomized divided into 12 week Proscar treatment group and control .The once follow-up every three weeks. The count ,area and swelling of the lesions were quantitative scored. The patients were also asked to fill out a DLQI questionnaire.3.After being administrated for 12 weeks, the pre and post level of sexual hormones were compared in order to study the influence that Proscar (Finasteride) affect .Results1. There were significant differences between female acne patients group and control group in T,DHT,FT and SHBG levels. The result showed that the serum FT levels in the patients were significantly higher than those in normal individuals ( P< 0.01). The serum levels of T and DHT were also significantly higher than those in normal individuals ( P< 0.05). The serum levels of SHBG in the patients were significantly lower ( P< 0.01) than those in normal individuals. There were no significant different among different severity grades of female acne patients in serum levels of sexual hormones.2. 40 patients were enrolled in the study. Patients were divided randomly into Proscar treatment group (20 patients) and control group (20 patients),no significant differences on age,history,and heredity between two groups .14 Patients were lost. In Proscar treatment group,2 patients(15.38%) were cured,4 patients(30.77%) were effected excellently,3 patients(23.08%) has effective results and 4 patients (30.77%) ineffective. In control group,no patients were cured,2 patients(15.38%) were effected excellently,3 patients(23.08%) has effective results and, 8 patients (61.53%) ineffective. The total effective rate of treatment groups is 69.23%, higher than the control of 38.46% (P<0.05).According to the quantitative symptoms scores system, the score of treatment group is significantly lower than the control (P<0.05).After DLQI questionnaire, the score of treatment group is significantly lower than the control (P<0.05).3. After treatment of finasteride, serum levels of DHT were significantly decreased (P<0.05),while SHBG were significantly increased(P<0.01). There were no significant differences between pre and post treatment in T and FT levels.The levels of T was significantly higher than the normal control group(P<0.05),but was within normal limits.ConclusionThe result showed that the serum T, FT and DHT levels in the female acne patients were higher than those in normal individuals. The serum levels of SHBG in the patients were lower than those in normal individuals. After being administrated for 12 weeks by Proscar, the symptoms were significantly improved.This result verified that the critical role that the androgen played in the pathogenesis of acne and the hypothesis that the pathogeneses mechanism of acne is an excessive function of the enzyme 5α-reductase. The therapy with finasteride (5 mg/day) is effective in the female patients with acne. |
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