Hormonal Acne

Routine cases - suspect when:

adult onset in female or adult worsening; premenstrual flares; acne on lower face

and neck; irregular menses with/without mild to moderate hirsutism

Hormone evaluation often normal even in hormonally produced acne - test non-

contributor except in late onset CAH increased (17 UH progesterone) and

tumor

Rx spironolactone or flutamide 2550-375/day with/without OCP with/without ABS

(also causes liver tox)

50-100/day with OCP with/without ABS

two to three months for response