Androgen-dependent acne
Androgen-dependent acne
- when hormones act directly on the skin -
Acne is one of the most common dermatological conditions and can occur both during adolescence and in adulthood. Although it is often associated with excess sebum, clogged pores, or bacterial overgrowth, the mechanisms that lead to the development of acne lesions are much more complex.
An important role is played by androgens, hormones that directly influence the activity of the sebaceous glands. In some people, the skin may have an increased sensitivity to the effects of androgens even when blood hormone levels are normal.
Understanding this mechanism has led to the development of new therapeutic approaches that act directly on androgen receptors in the skin, without necessarily aiming to alter systemic hormone levels.
An important role is played by androgens, hormones that directly influence the activity of the sebaceous glands. In some people, the skin may have an increased sensitivity to the effects of androgens even when blood hormone levels are normal.
Understanding this mechanism has led to the development of new therapeutic approaches that act directly on androgen receptors in the skin, without necessarily aiming to alter systemic hormone levels.
What role do androgens play in the development of acne?
Androgens, such as testosterone and dihydrotestosterone, are hormones present in both men and women. In the skin, they interact with androgen receptors found in the sebaceous glands as well as other skin structures. Activation of these receptors stimulates sebum production and may contribute to changes within the pilosebaceous unit.
Sebum normally plays an important role in protecting the skin. When it is produced in excess and is associated with follicular hyperkeratinization, pores can become clogged more easily, promoting the formation of comedones and the development of inflammation. For this reason, androgenic activity is an important component of the mechanism involved in the development of acne.
Sebum normally plays an important role in protecting the skin. When it is produced in excess and is associated with follicular hyperkeratinization, pores can become clogged more easily, promoting the formation of comedones and the development of inflammation. For this reason, androgenic activity is an important component of the mechanism involved in the development of acne.
What is androgen-dependent acne?
The term androgen-dependent acne does not necessarily imply the presence of a hormonal disorder.
Some people have normal levels of circulating hormones, but their sebaceous glands may respond more strongly to androgenic stimulation. The sensitivity of androgen receptors and the local metabolism of hormones in the skin may therefore influence the severity of acne.
In adult women, hormonal involvement may be suggested by the persistence or onset of acne after adolescence, its predominant distribution along the jawline and chin, or the cyclical worsening of lesions. However, the clinical presentation alone is not sufficient to establish a hormonal cause, and additional investigations are recommended only when the doctor considers that there are signs suggestive of an endocrine imbalance.
In adult women, hormonal involvement may be suggested by the persistence or onset of acne after adolescence, its predominant distribution along the jawline and chin, or the cyclical worsening of lesions. However, the clinical presentation alone is not sufficient to establish a hormonal cause, and additional investigations are recommended only when the doctor considers that there are signs suggestive of an endocrine imbalance.
Why can acne persist into adulthood?
Adult acne is a multifactorial condition. Increased sebum production, changes in follicular keratinization, inflammation, and the activity of Cutibacterium acnes interact with one another and contribute to the development of acne lesions.
Hormonal factors may be an important component, particularly in certain forms of adult female acne.
Stress, the use of unsuitable cosmetic products, certain medications, and genetic predisposition may also influence the course of the condition. For this reason, treatment is not the same for everyone and should be adapted to the type of lesions, their severity, and the predominant underlying mechanisms.
Hormonal factors may be an important component, particularly in certain forms of adult female acne.
Stress, the use of unsuitable cosmetic products, certain medications, and genetic predisposition may also influence the course of the condition. For this reason, treatment is not the same for everyone and should be adapted to the type of lesions, their severity, and the predominant underlying mechanisms.
How is acne treated?
Acne treatment may include topical or systemic therapies, depending on the severity of the condition and the individual characteristics of each patient.
Commonly used substances include topical retinoids, benzoyl peroxide, azelaic acid, and certain antibiotics. In moderate or severe forms, may be recommended: systemic treatments, including antibiotics, hormonal therapies, or isotretinoin.
For patients in whom the androgenic component plays an important role, the doctor may also consider therapies that interfere with androgen activity.
Some of these treatments act systemically. More recently, it has also become possible to block androgen receptors directly in the skin.
Commonly used substances include topical retinoids, benzoyl peroxide, azelaic acid, and certain antibiotics. In moderate or severe forms, may be recommended: systemic treatments, including antibiotics, hormonal therapies, or isotretinoin.
For patients in whom the androgenic component plays an important role, the doctor may also consider therapies that interfere with androgen activity.
Some of these treatments act systemically. More recently, it has also become possible to block androgen receptors directly in the skin.
What is clascoterone?
Clascoterone is a topical androgen receptor inhibitor developed for the treatment of acne.
Unlike orally administered hormonal therapies, clascoterone is applied directly to the skin and acts predominantly locally.
In the sebaceous glands, dihydrotestosterone binds to the androgen receptor and activates mechanisms involved in sebum production and inflammatory processes associated with acne. Clascoterone competes with androgens for binding to this receptor, reducing androgen signaling locally.
This approach differs from conventional acne treatments because it does not act primarily on bacteria or skin exfoliation, but rather on one of the hormonal pathways involved in the development of acne lesions.
Unlike orally administered hormonal therapies, clascoterone is applied directly to the skin and acts predominantly locally.
In the sebaceous glands, dihydrotestosterone binds to the androgen receptor and activates mechanisms involved in sebum production and inflammatory processes associated with acne. Clascoterone competes with androgens for binding to this receptor, reducing androgen signaling locally.
This approach differs from conventional acne treatments because it does not act primarily on bacteria or skin exfoliation, but rather on one of the hormonal pathways involved in the development of acne lesions.
What have clinical studies shown?
Topical clascoterone has been evaluated in randomized clinical trials involving patients with moderate to severe facial acne.
The results showed a reduction in both inflammatory and non-inflammatory lesions compared with the vehicle without the active ingredient.
The tolerability profile observed in clinical trials was favorable, with most local reactions being mild.
Clascoterone is also currently included in international treatment guidelines for acne management, providing an additional option as part of individualized treatment.
The tolerability profile observed in clinical trials was favorable, with most local reactions being mild.
Clascoterone is also currently included in international treatment guidelines for acne management, providing an additional option as part of individualized treatment.
Can clascoterone be used with other treatments?
Acne develops through several mechanisms acting simultaneously, which is why treatment often combines substances with different mechanisms of action.
Androgen receptor blockade can target the hormonal component, while other substances may help control hyperkeratinization, inflammation, or bacterial proliferation.
Depending on the type of acne and skin tolerability, the doctor may decide to combine several topical therapies or to combine topical treatment with systemic therapy.
Treatment combinations should be individualized to minimize irritation and avoid the unnecessary use of multiple products.
Depending on the type of acne and skin tolerability, the doctor may decide to combine several topical therapies or to combine topical treatment with systemic therapy.
Treatment combinations should be individualized to minimize irritation and avoid the unnecessary use of multiple products.
What is the role of compounded treatments?
Compounded treatments can play an important role when the doctor considers it necessary to personalize topical treatment. They allow the concentration to be adjusted, the selection of a vehicle suitable for the patient’s skin type, and, when formulation compatibility and stability allow, the combination of active ingredients with complementary mechanisms of action.
In the case of an active ingredient such as clascoterone, the choice of pharmaceutical base is important because it must ensure proper dispersion of the active ingredient, formulation stability, and uniform application to the skin.
Compounded preparations are prepared based on the doctor’s recommendation, with the formulation determined according to the patient’s needs and the physicochemical properties of the ingredients used.
In the case of an active ingredient such as clascoterone, the choice of pharmaceutical base is important because it must ensure proper dispersion of the active ingredient, formulation stability, and uniform application to the skin.
Compounded preparations are prepared based on the doctor’s recommendation, with the formulation determined according to the patient’s needs and the physicochemical properties of the ingredients used.
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