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What role do glucocorticoids play in acne treatment?

Dr. Doris Day, MD
Dermatology
Glucocorticoids, such as prednisone or dexamethasone, in low doses can suppress the adrenal production of androgens. Glucocorticoids can be used in male or female patients who have an elevation of dehydroepiandrosterone sulfate in the serum associated with a decrease in levels of 11- or 12-hydroxylase. These are measured through blood tests. Glucocorticoids can also be used to treat instances of acute acne flares in very severe cases of acne for a few weeks. Low-dose prednisone (2.5 or 5 mg) or dexamethasone (0.25 to 0.75 mg) can be given by mouth at bedtime to suppress adrenal androgen production. Side effects include other unwanted signs of adrenal suppression and can be followed with specific tests every 2 to 3 months after treatment is started. The combination of glucocorticoids and estrogens has been used in recalcitrant acne in women with excellent results. The doses of estrogens typically used, however, are higher than the typical dose of estrogen used in oral contraceptives.

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