Skin Diseases Due to Increased Androgen Sensitivity

In an inherited genetic hypersensitivity, normai levels of androgens may cause cosmetic disturbances or even dermatologica! diseases: acne and alopecia. The cosmetic dermatologist is called for help. Androgenetic stimulation leads to increased levels of sebum, to an imbalance of lipids on the skin surface, to follicular hyperkeratosis and, finally, to the fonnation of comedones. In those patients with hypersensitive sebocytes, only cosmetic disturbances are present at the beginning but a rapid progression towards an embarassing skin disease with severe symptoms in the face is possible. An aggravation of Acne comedonica into Acne papulopustulosa and Acne conglobata has to be considered in each case. Therapy starts with adequate skin cleansing and comedonolytic skin care, e. g. with topica! adpalene, and may continue in severe cases with oral isotretinoin. In females, antiandrogens may be given to reduce the androgenic stimulation of sebocytes. Other patients reveal high levels of androgen receptors and testosterone-activating steroid-5a-reductase in the frontal areas and in the vertex of the scalp (balding areas). As a consequence, androgenetic alopecia develops. Although hair loss is generally regarded as a cosmetic disturbance, the patients afflicted from this disease suffer from their reduced self-esteem and their impaired psychological and social well-being. This matters for women and men, especially for young men. Androgenetic alopecia is a disease that needs help, from the doctor, from the pharmacist, and, on the first hand, from the cosmetic dermatologist. But only suppressive measures are known today. Topica! minoxidil or topica! l 7a-estradiol will stop hair loss in the vast majority of cases. Life-long treatment may be necessary, however. Only recently, oral finasteride has been shown to be highly effective in suppressing hair loss in androgenetic alopecia. However, the undesirable actions of this drug warrant a most criticai and cautious application.