To the Editor.—
We read with interest the report by Ghetti et al,1 in which they treated three female patients affected by acne with ketoconazole (300 mg twice daily) and found both an improvement in the acne and a reduction in the total testosterone levels.We have also considered using ketoconazole in the treatment of acne, on the basis that its known inhibition of testosterone synthesis should produce a reduction in the sebum excretion rate (SER). We performed a pilot SER study on seven patients without acne who were taking ketoconazole (200 mg daily) for superficial fungal infections over a period of eight to 12 weeks (Table).The changes in SER were variable and would not, in our experience, be sufficient to significantly influence the clinical course of acne. These results should be contrasted with the almost universal 80% reduction in SER produced by isotretinoin (Roaccutane) after only eight weeks of therapy.2We did not use as large a dose of ketoconazole as Ghetti et al, and it may be that such high, but potentially more dangerous, doses are necessary for a significant effect on the SER.
Norris JF, Cunliffe WJ. Effect of Ketoconazole on Sebum Excretion Rate. Arch Dermatol. 1987;123(3):301. doi:10.1001/archderm.1987.01660270033010