Introduction: Acne is a chronic inflammatory disorder of the pilosebaceous unit with differential pathogenesis. To elucidate the roles of hormones in acne pathogenesis, we conducted a study to evaluate the plasma testosterone, estradiol, and progesterone levels in women with acne vulgaris.

Methods: We conducted a cross-sectional descriptive study, and 140 women with acne vulgaris were examined; their plasma estradiol, progesterone, and testosterone were analyzed by chemiluminescence technique and compared with the healthy control group.

Results: Increased plasma hormone levels in women with acne vulgaris accounted for 33.57%, and hyperandrogenism accounted for 20.71% of cases. We found significant differences in testosterone levels (mean value, 56.92 ± 27.64ng/dL, 60.71± 25.85ng/dL versus 38.35 ± 10.09ng/dL, p<0.05), respectively, in the moderate to severe acne group and the control group. However, the estradiol level of the moderate and severe acne groups (325.12 ± 91.79 and 305.26 ± 83.01pmol/l) was lower than the control group (368.6 ± 58.34pmol/l), with p-value under 0.05. No statistically significant differences were found for progesterone levels. 

Conclusion: Our study showed that female patients with moderate to severe acne vulgaris had abnormalities in plasma testosterone and estradiol levels. These abnormalities might be part roles in the pathogenesis of acne vulgaris, even when the mean levels were in the normal range. Female patients suffering from premenstrual acne flares might be examined for plasma testosterone levels.

We selected female acne patients aged between 16 and 30 who had not received drugs causing acne (glucocorticoids, lithium, isoniazid, phenytoin, selective reuptake serotonin inhibitors) or hormonal therapy (hormonal contraceptive and anti-androgen therapy) for at least three months before joining the study. Age-matched healthy volunteers without acne, pregnancy, or lactation served as the control group. None of the participants had been treated with hormonal treatment at this time of the study. All patients of each group were asked about history taken, throughout local and general clinical examinations to rule out any suspected similar diagnosis or other local and systemic disorders which contraindicate the patients from participating in this study. PCOS was also excluded by the manifestation of hyperandrogenism (hirsutism, oligomenorrhea) and confirmed with transvaginal and pelvic ultrasound.

Acne severity grading: The severity of acne was determined according to the Global Acne Grading System (GAGS). ⁶Each type of acneiform lesion has a gravity score: no lesions: 0; comedones: 1; papules: 2; pustules: 3; and nodules: 4. The local score was calculated using factor × grade 0-4. Depending on the acne lesion location, the factor had the following values: forehead: 2; right cheek: 2; left cheek: 2; chin: 1; thorax and upper torso: 1. The sum of the local scores was the global score which settled acne severity. In our study, a global score of 1-18 signified mild acne, 19-30 was moderate acne, and a global score > 31 was severe acne.

Endocrine evaluation: Each patient performed a hormonal profile, including testosterone, estradiol, and progesterone. Blood samples were collected at 08:00 am on the second to the fourth day of menses (the follicular phase of the menstrual cycle). Each 4 mL of venous blood was centrifuged and plasma stored at -20°C. Hormone levels were measured by using direct chemiluminescent technology in the Unicel ^® DXI800 machine. Units: testosterone for ng/dL, estradiol for pmol/L, progesterone for ng/mL. Women’s testosterone normal levels were considered as ≤0.86 ng/mL; estradiol ranged from 74–532 pmol/L; progesterone was ≤1 ng/mL.

The readme file contains an explanation of each of the variables in the dataset, its measurement units, and -if it concerns a derived variable (displayed in grey) - the way it was calculated from the primary data (displayed in black). #NA =  values not available. Information on how the measurements were done can be found in the associated manuscript referenced above.