Abstract
The pathogenesis of acne vulgaris has only been partially elucidated. Various hormones, especially androgens, are likely to play a role, but results of studies are still inconclusive. The objective of the current study was to investigate whether day to day variation in salivary testosterone correlates with acne in males. Saliva samples were collected for 120 consecutive days from each of the 40 males. Salivary testosterone concentrations were measured by enzyme-linked immunosorbent assay (ELISA). Facial acne lesions were assessed on a daily basis by photography by the participating males. Potential confounders’ (sexual intercourse, masturbation, physical exercise and disease) were also registered every day by the participants. A significant but weak association between salivary testosterone and acne was found (n = 4602, r = 0.031, P = 0.034). Elevated testosterone concentrations were associated with an increase in acne, but when testosterone concentrations were above twice the individual average, acne lesions paradoxically decreased. The current results indicate that daily fluctuations in salivary testosterone levels in males are associated with acne patterns, but the weak correlation suggests that the effect is too small to be of clinical significance. The analysis in the current study was complicated by a large number of days on which the participants had no acne, as well as the seemingly non-monotonic relation between testosterone and acne. This may indicate that the actual relation is stronger than concluded here.
Highlights
Acne is a non-infectious, chronic inflammation of the pilosebaceous unit [1]
Both clinical and experimental evidence support the role of androgens in stimulating sebum production: (i) the presence of acne in the prepubertal period correlates with serum levels of dehydroepiandrosterone sulfate (DHEAS), an adrenal precursor for synthesis of testosterone [3, 4], (ii) subjects who lack functional androgen receptors do not produce sebum, and do not develop acne [3], (iii) tumors of the ovary or the adrenal gland that are androgen producing are often associated with the development of acne [3], (iv) systemic administration of testosterone and DHEAS increases the size of the sebaceous glands and stimulates sebum production [3, 5], (v) severe acne is Journal of Controversies in Biomedical Research 2018; 4(1): 1–5 often associated with conditions of hyperandrogenism and increased sebum production [2, 3, 5]
There was no significant correlation between the number of acne lesions and the salivary testosterone levels recorded the day before (n = 4566, r = 0.026, P = 0.082), 2 days before (n = 4532, r = 0.003, P = 0.865), 3 days before (n = 4497, r = −0.006, P = 0.673), 4 days before (n = 4460, r = 0.022, P = 0.143), or 1 day after (n = 4563, r = 0.022, P = 0.129)
Summary
Acne is a non-infectious, chronic inflammation of the pilosebaceous unit [1]. It is the most common skin disease affecting at least 85% of adolescents [2]. At least four factors have been included to have a role in its development: hyperkeratinization of the sebaceous follicles and development of a keratin plug that may obstruct the outflow of the sebum to the skin surface, increased sebum production, microbial hypercolonization of the pilosebaceous units by Propionibacterium acnes, and secondary follicular inflammation [1]. It has been suggested that hormones affect h yperkeratinization of the sebaceous follicles [5]
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