The association of increased androgen receptor sensitivity with the severity of acne and concomitant androgen‑dependent conditions in women.

BACKGROUND: In women, acne may persist beyond adolescence or develop in adulthood. Androgen-dependent manifestations despite normal androgen levels may reflect variation in target-tissue receptor responsiveness, including CAG repeat length in the androgen receptor (AR) gene AIM: To evaluate the association between an operational marker of increased AR sensitivity, acne severity, and androgen-dependent conditions. METHODS: This single-center cross-sectional study included 101 women with papulopustular acne. AR CAG repeat length was determined in buccal epithelial samples by denaturing high-performance liquid chromatography. Analyses were based on the shorter allele, with ≤19 repeats considered a marker of increased AR sensitivity. Group I included 31 women without the marker and group II included 70 with it. Assessments included GAGS, sebometry, Ferriman–Gallwey score, Ludwig grade, and PCOS. Between-group comparisons used the Mann–Whitney U, Pearson’s chi-square, and Fisher’s exact tests; correlations were assessed using Spearman’s rank coefficient. RESULTS: Median GAGS scores were 32 [31–33.3] in group II versus 20.5 [14–24.3] in group I; median sebum output was 310 [287.5–340] versus 240 [230–250] μg/cm², and median Ferriman–Gallwey scores were 14 [0–19] versus 0 [0–0], respectively (p0.001). Ludwig grade II–III alopecia occurred in 50.0% of group II and was absent in group I. PCOS prevalence was 57.1% and 10.0%, respectively (p0.001). GAGS scores correlated with sebum production, alopecia severity, hirsutism, and total testosterone in both groups CONCLUSION: The marker of increased AR sensitivity was associated with greater acne severity, higher sebum production, and androgen-dependent conditions. The cross-sectional design does not permit causal inference