Objective — to determine the efficacy, safety, tolerability of the complex therapy, which includes flutamid, in women with acne affected by hyperandrogenism.Materials and methods. During 2014—2017, there were 117 women under observation who had acne illness of varying degrees of severity. The age of the patients varied from 18 to 35, the average age was (28.2 ± 3.2) years. The duration of the disease was from 1 to 8 years, on average — (4.5 ± 0.5) years. The prevalence of acne in the age group of 18 to 25 years was 32 %; in the group of 25—30 years — 29 %; in the group of 30 — 35 years — 39 %. The hormonal status was studied on the third — fifth day of the menstrual cycle by the definition of luteinizing hormone, progesterone, total and free testosterone, antimullerian hormone before treatment and at 1, 3, 6 months of the therapy; the sonographic assessment of the pelvic organs was performed on the second — fourth day of the menstrual cycle before treatment and at the sixth month of therapy. For all women with acute acne and hyperandrogenism, complex therapy was conducted with the prescription of one of the systemic antibiotics of the azithromycin rank or retinoid and included flutamid in the dose of 125 mg 3 times per day for 6 months and the appointment of external treatment.Results and discussion. 82 (70 %) patients had second — third degree of severity (clinical course of moderate severity), 35 (30 %) patients — fourth degree of severity (severe clinical course). 92 (78.6 %) patients had hyperandrogenism on the background of polycystic ovarian syndrome, the remaining 25 (21.4 %) patients had a mixed type of hyperandrogenism. During the first two weeks of the complex therapy 104 (89 %) patients, showed significant improvement, revealed as regression of comedones and superficial papulapustular elements of skin rash, and the maximum effect was achieved only after 6 weeks of therapy. In 13 (11 %) patients, skin clearing from the rash was slower and the significant clinical improvement was achieved after three months of therapy. Complete clinical recovery, revealed as complete absence of any signs of inflammation on the skin, was observed in 117 patients who had undergone the full course of six months of treatment. Analysis of the average values of laboratory parameters after the treatment showed the decrease of the total and free testosterone levels by 4 and 3.5 times, respectively, of the luteinizing and antimullerian hormone — by 2.7 and 1.8 times, respectively, the increase of progesterone level — by 1.5 times. Longterm results of treatment allowed marking steady clinical remission for one year after treatment in 111 (95 %) women. Positive changes of sonographic evaluation (ultrasonic diagnosis) after the treatment were noted in 70 (60 %) women, which were revealed as decrease of the thickness of capsules and the decrease or disappearance of small hypoechoic inclusions along the ovarian stroma.Conclusions. The necessary condition for the increase of the effectiveness of treating patients with acne is the correction of all links of the pathogenesis of the disease. With a similar clinical symptomatology, a different tactics of management of patients, aimed at a particular pathogenetic cause, will be required. Since laboratory diagnostics makes it possible to understand the individual links of the pathological process, for female acne patients, primarily of reproductive age, an evaluation of the androgenic status is required – detection of biochemical hyperandrogenism and analysis of the degree of androgen level increase, – which makes it possible to implement the appropriate changes in the treatment, including acne disease. To interrupt hyperandrogenism link in women with acne, confirmed by biochemical and instrumental studies, it is advisable to administer flutamide 125 mg 3 times a day for a total of 6 months in a complex therapy with a possible dose adjustment.
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Nov 30, 2018
L.B Markin + 1
Open Access