A prospective observational study on the correlation between hormonal profiles and acne severity in women with adult-onset acne.

Abstract

Background:
Adult-onset acne (AOA) is increasingly prevalent among women and is often refractory to conventional therapy. Hormonal fluctuations, hyperandrogenemia, and metabolic disturbances are recognized contributors, yet the correlation between hormonal profiles and acne severity remains under-defined in Indian women. To evaluate the relationship between serum hormonal parameters and the severity of acne in women presenting with adult-onset acne.

Methods:

A prospective observational study was conducted among 100 women aged 18–40 years with clinically diagnosed AOA attending a tertiary dermatology OPD. Detailed clinical assessment, menstrual and family history, and Global Acne Grading System (GAGS) scoring were performed. Fasting serum levels of total and free testosterone, DHEA-S, SHBG, LH, FSH, prolactin, TSH, 17-hydroxyprogesterone, and fasting insulin (HOMA-IR) were estimated. Correlations between hormonal parameters and acne severity were analyzed using Spearman’s rank test and multivariate logistic regression.

Results:

The mean age of participants was 26.8 ± 4.9 years. Menstrual irregularity and PCOS were observed in 38% and 41% respectively. Based on GAGS, 28% had mild, 46% moderate, and 26% severe acne. Elevated free testosterone (34%), total testosterone (29%), and reduced SHBG (26%) were the most frequent hormonal abnormalities. Acne severity correlated positively with free testosterone (ρ = 0.41, p < 0.001), total testosterone (ρ = 0.32, p = 0.002), DHEA-S (ρ = 0.29, p = 0.004), and LH/FSH ratio (ρ = 0.24, p = 0.016), while SHBG showed an inverse correlation (ρ = −0.33, p = 0.001). PCOS and insulin resistance significantly amplified the severity.

Conclusion:

Hormonal imbalance, particularly elevated free testosterone and low SHBG, plays a crucial role in the pathogenesis and severity of AOA. Recognition of underlying endocrine dysfunction is essential for comprehensive management.

Recommendations:

Routine hormonal evaluation should be incorporated in women presenting with persistent or severe AOA to guide individualized hormonal or metabolic therapy, ensuring optimal and sustained outcomes.