Acne results from the increased production of sebum and the accumulation of sebum in the sebaceous duct. Androgens have a direct influence on this condition as they stimulate both the formation of sebum and the hyperkeratinisation of the upper part of the duct which leads eventually to its obstruction.
Clinical tests have demonstrated that most acne patients do not have an increased level of androgen in the blood. They do, however, show an increased conversion of testosterone to 5-alpha-dihy-drotestosterone (5-alpha-DHT) in the skin. This latter hormone is responsible for the stimulation of the sebaceous gland. The enzymic conversion of testosterone to 5-alpha-DHT can be inhibited by progesterone.
Progesterone, when applied topically in an alcohol/water solution, is 80 percent metabolized in the skin and is not converted into androgens in the body. It may therefore be expected that the topical application of progesterone will not give rise to side effects in either men or women. Preliminary trials are in agreement with this expectation.
Extensive clinical investigations of an alcohol/ water solution of progesterone are therefore recommended, as this may be the first clinically useful, locally active, antiandrogen to be effective in the treatment of acne.
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