THE STUDY by Lucky et al1 in this issue of the Archives clearly confirms the observation that acne may be the earliest sign of puberty. This investigation, as well as other recent publications, identifies adrenal androgen as a significant factor in prepubertal acne. Furthermore, since adrenarche precedes menarche, early acne is associated with, and a marker of, adrenarche. Finally, Lucky et al have contributed significantly to our understanding of the role of adrenal androgens in early acne. One can reasonably hope that a better understanding of the initial stages of acne may lead to superior intervention at a younger age with the expectation that one may then prevent the subsequent evolution of this stubborn and troublesome disease.
Androgens have been known to play a role in the pathogenesis of acne since the early 1940s when J. B. Hamilton described ''male hormone substance'' as a factor in acne. Since then
Shalita AR. Acne Revisited. Arch Dermatol. 1994;130(3):363-364. doi:10.1001/archderm.1994.01690030095016