It is quite likely that there is a spectrum of androgen dysfunction in acne patients. A small number of patients with acne are hirsute and have ovarian dysfunction and  investigations,  including  ultrasonography, will show them to have such problems as the polycystic syndrome and mild congenital adrenal hyperplasia. Most acne patients are clinically otherwise normal.

 

   Reingold and Rosenfield proposed a model, in which the apparent sensitivity of the skin to androgens is an important factor  in  pilosebaceous  activity, as is  the plasma androgen level.39 It is proposed that there is an heterogeneity in the pilosebaceous sensitivity - but why is not clear. Lack of hirsutism in many women with acne suggests relative insensitivity of the hair follicle to androgen or an excess sensitivity of the sebaceous gland to the hormone. Resistance to the effects of androgen is known to result from a variety of genetically determined defects in their mode of action, including 5a-reductase deficiency and DHT receptor disorders.

 

  Despite  the  lack  of detailed  knowledge  of these androgen interrelationships the  clinician  has  drugs, both hormonal and nonhormonal, which will  significantly reduce the seborrhoea (and which possibly, at the same time,  may  reduce the androgen-controlled duct hypercornification) and markedly improve acne.