The effect of isotretinoin usage on hirsutism development in patients with acne vulgaris

Background: Acne vulgaris is a chronic inflammatory disease of the pilosebase unit that contains hair follicles associated with the sebaceous gland. Androgen hormones play an important role in the pathogenesis of acne. Isotretinoin stands out as the most effective treatment in acne treatment. However, the effect of isotretinoin usage on hormonal changes in acne pathogenesis is not fully known, there are a limited number of studies on the effects of hirsutism development. In this study, it was aimed to evaluate the effect of isotretinoin usage on hirsutism and hormonal parameters in patients with follow-up due to acne vulgaris. Materials and Methods: This study was conducted between June 2018 and December 2019 in the Van Yüzüncü Yıl University, Faculty of Medicine, and Department of Dermatology. 30 female patients, aged between 18 and 40 years, who were diagnosed with acne vulgaris and receiving isotretinoin therapy and 30 healthy volunteers as control group were taken prospectively. In the study, a form including anamnesis, physical examination and laboratory tests was created for the patients in accordance with the study. Results: 33.3% of cases at the third months of follow-up had menstrual irregularities, 30% of cases had family history positivity and 30% of cases had severe acne. Menstrual irregularity at third months of follow-up was statistically significantly higher in the patient group compared to the control group (p=001). Ferriman-Gallwey hirsutism score was ≥8 in 16.7% of the cases at the third months of follow-up. In the patient group, menstrual irregularity (p<001) and Ferriman-Gallwey hirsutism score (p=0.023) at the third months of follow-up were statistically significantly higher than the first admission. There were abnormal findings in pelvic ultrasonography in 10% of the cases at the third months of follow-up. The progesterone level of cases at the first admission was statistically significantly higher than the progesterone level observed at third months (p <0.001). Progesterone (p=0.007) and estradiol (p=0.001) levels at the first admission in patients group were statistically lower than the control group. Discussion and Conclusion: Hormones, the interaction of hormones with each other and some interactions at the molecular level play an important role in the etiopathogenesis of acne vulgaris. Isotretinoin, which is still seen as the most effective option in the treatment of acne vulgaris, has not been demonstrated to have a significant effect on the pituitary, adrenal hormones and insulin resistance. In our study, we found that three-month isotretinoin treatment caused an increase in menstrual irregularity and Ferriman-Gallwey hirsutism score. Further studies are required for both the etiopathogenesis of acne vulgaris and the effects of isotretinoin.