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Acne vulgaris - Management
How should I investigate the cause of acne in a woman?
- Diagnostic investigations are not necessary for the management of acne vulgaris unless it is suspected as being secondary to an underlying cause in women. Hyperandrogenism should be suspected if the woman has:
- Irregular periods, androgenic alopecia (hair thinning on the front of the scalp), or excessive facial or body hair (hirsutism).
- Acne resistant to conventional treatment (including oral antibiotics), or there is a rapid relapse after a course of oral isotretinoin.
- A sudden onset of severe acne.
- If hyperandrogenism is suspected, consider the following investigations:
- Total and free testosterone — elevated levels may indicate polycystic ovarian syndrome (PCOS) or, rarely, ovarian cancer.
- Luteinizing hormone/follicle-stimulating hormone (LH/FSH) ratio — may be altered in PCOS, with elevated LH.
- Serum dehydroepiandrosterone (DHEA) — elevated levels may indicate adrenal tumour or congenital adrenal hyperplasia.
- 17-hydroxyprogesterone — elevated levels may indicate congenital adrenal hyperplasia.
- Prolactin — may reveal hyperprolactinaemia.
- 24 hour urinary-free cortisol — elevated levels may indicated Cushing's disease or syndrome.
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