Why Isn’t My Acne Getting Better?

Occasionally, a person will consult a dermatologist for treatment of her acne and is disappointed with the results. Despite many months of treatment with several different medications, she never gets really satisfactory results. There are still the pimples and, even worse, possibly excess hair growth.

When women experience this, particularly adult women, they frequently have an overproduction of their male hormones, a condition known as an androgen excess. It may also be labeled as Polycystic Ovarian Syndrome (PCOS), Syndrome X or Metabolic Syndrome. No matter the name, until the source of the androgen excess is identified and appropriately treated, the acne and/or hair growth will continue despite the use of dermatologic creams, ointments or pills. Most dermatologists are not prepared to conduct these studies and administer the indicated treatment.

While some androgens, or male hormones, are produced through conversion of precursors at other sites, all androgens in women are derived either directly or indirectly from the adrenal glands or the ovaries. Occasionally, this may be associated with a mild, enzyme defect in one or both of these organs. By first documenting the presence of an androgen excess and then determining the source of the excess, therapy can be tailored to the individual patient’s needs, assuring an optimization of success.

The ideal person to perform this evaluation and treatment is a reproductive endocrinologist who makes this a focus of their practice (as opposed to concentrating on IVF). In this setting, optimal therapy with a resolution of the acne and hair growth can be expected.

Gerald V. Burke, M.D.