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March 1994

Acne Vulgaris in Premenarchal Girls: An Early Sign of Puberty Associated With Rising Levels of Dehydroepiandrosterone

Author Affiliations

From the Departments of Dermatology (Dr Lucky), Pediatrics (Dr Lucky), and Internal Medicine, Division of Biostatistics (Ms Huster and Mr Leach), University of Cincinnati College of Medicine; Division of Pediatric Dermatology (Dr Lucky) and Adolescent Medicine (Dr Biro) and the Department of Cardiology (Dr Morrison), Children's Hospital Medical Center; and Dermatology Research Associates (Dr Lucky and Ms Ratterman), Cincinnati, Ohio.

Arch Dermatol. 1994;130(3):308-314. doi:10.1001/archderm.1994.01690030040006

Background:  This study examined the relationships of pubertal maturation and sex steroid hormones to the development of acne in young girls. Black (n=317) and white (n=306) premenarchal girls with a mean age of 9.97±0.62 years were evaluated for acne prevalence and severity, pubic hair and areolar maturation, and sex steroid hormone levels.

Results:  Overall, 77.8% of the girls had some acne; of the whole group, 48.3% had only comedonal acne, 2.2% had only inflammatory acne, and 27.3% had both types. Although black girls matured at an earlier age than white girls, racial differences in acne were minimal when adjusted for pubertal maturation. Acne increased with advancing maturation; at Tanner pubic hair stages 1, 2, and 3, the prevalence of acne rose from 73.1% to 84.0% and to 90.6%, respectively. Acne lesion counts at seven facial locations revealed a predominance of midfacial acne on the middle aspect of the forehead, nose, and chin. Sex steroid hormone levels measured in 365 of the girls were found to increase significantly during maturation from prepuberty to early puberty. Testosterone-estrogen—binding globulin and the ratio of testosterone to estradiol decreased. In 118 prepubertal girls, estradiol, total and free testosterone, progesterone, testosterone to estradiol ratio, and testosterone-estrogen—bindingglobulin levels were no different whether in subjects with acne or without acne. However, the level of dehydroepiandrosterone sulfate, an androgen of adrenal origin, was significantly higher in prepubertal girls with acne.

Conclusion:  Acne, especially the comedonal type, can be the first sign of pubertal maturation in girls, even preceding pubic hair and areolar development. Concentration of dehydroepiandrosterone sulfate is significantly and specifically associated with the initiation of acne in young girls.(Arch Dermatol. 1994;130:308-314)

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