Objective: To determine if there are differences in the activity of 17β-hydroxysteroid dehydrogenase and 5α-reductase (responsible for the production of testosterone and dihydrotestosterone, respectively) in sebaceous glands obtained from men and women with and without acne. Design: Single-center examination of androgen levels and sebaceous gland enzyme activity in a cohort of volunteers. Setting: Academic referral center. Patients: Thirty-four subjects, consisting of 8 women with acne, 10 women without acne, 8 men with acne, and 8 men without acne. Interventions: Single visit for blood sampling and 2 biopsies of forehead skin. Main Outcome Measures: Serum levels of androgens were determined and compared with the activity of 5α-reductase and 17β-hydroxysteroid dehydrogenase in sebaceous glands microdissected from skin samples. Results: No significant differences in the activity of 5α-reductase or 17β-hydroxysteroid dehydrogenase in sebaceous glands according to the presence of acne were noted in either men or women. The activity of 5α-reductase and 17β-hydroxysteroid dehydrogenase was significantly greater in sebaceous glands from men (n = 16) than women (n = 17). The oxidative activity of 17β-hydroxysteroid dehydrogenase was 2-fold higher in men than women. Serum levels of dehydroepiandrosterone sulfate, androstenedione, testosterone, and dihydrotestosterone were significantly higher in women with acne than in women without acne. No differences in serum androgen levels were noted in men on the basis of the presence of acne. Conclusions: Higher serum androgen levels are associated with the presence of acne in women. A role for locally produced androgens in this process, however, cannot be excluded.
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