Female Adult Acne and Androgen Excess

A Report From the Multidisciplinary Androgen Excess and PCOS Committee

Enrico Carmina; Brigitte Dreno; W. Anne Lucky; W. George Agak; Anuja Dokras; Jin Ju Kim; Rogerio A. Lobo; Fahimeh Ramezani Tehrani; Daniel Dumesic


J Endo Soc. 2022;6(3) 

In This Article

Summary Recommendations for Diagnosis and Treatment of Female Adult Acne

The AE-PCOS task force, after a careful evaluation of all available data, issued some recommendations for diagnosis and treatment of female adult acne.

  1. Diagnosis of female adult acne is mainly clinical, but a grading tool is needed for optimizing the treatment (level of evidence B).

  2. Measurement of serum androgen values (total testosterone, free testosterone, and DHEAS) by high-quality assays is recommended in all women with adult acne (level of evidence A).

  3. In women with adult acne and proven hyperandrogenism, oral combined estroprogestins should be added to the topical or systemic treatment of acne, independently of severity of acne (level of evidence A).

  4. All second- and third-generation estroprogestins may be used, independently of the estrogen dose and progestin component (level of evidence B).

  5. Spironolactone may be added to estroprogestins in women with moderate or severe hyperandrogenic adult acne not responding to usual treatments (level of evidence B).

  6. Estroprogestins may be used in nonhyperandrogenic patients with adult acne as second-line therapy (level of evidence B).