The treatment of acne with TACE.

Although many factors have been cited as the cause of acne, it has become apparent that hormonal inIfuences play a major role in its development. Hamilton (1) presented convincing evidence that testosterone propionate would produce acne in susceptible individuals and pointed out the absence of acne in eunuchs. It has been found, too, that the administration of ACTH and cortisone, both of which have androgenic qualities, is followed in some cases by the development of acne (2). While a preponderance of androgenic hormones is often followed by acneform eruptions, it cannot be stated categorically that such excesses in themselves account for the disturbance because there is a concomitant alteration of the estrogen—androgen ratio. In a number of patients suffering from acne, it was found (3) that there was a moderate increase in the urinary excretion of androgen and a moderate decrease in the urinary excretion of estrogen which resulted in altered ratio. On the other hand, Lawrence and Werthessen (4) noted a decrease in urinary estrogen with no significant change in the excretion of urinary androgen, but they felt that the resulting increased ratio of androgen to estrogen was the responsible inciting factor. The occurrence of premenstrual exacerbation of acne is well known and has been ascribed to the fact that at this period during the menstrual cycle, estrogen levels are at their lowest and, as a result, the androgen—estrogen ratio is elevated (5—7). In an effort to restore the endocrine balance, estrogens have been administered to patients suffering from acne, with varying results. Sulzberger (2), reporting on the therapeutic effect of female sex hormones in refractory cases of acne, stated that in one-third of these patients such hormones were a valuable adjuvant, but untoward reactions occurred in a large number of cases. Nausea, delayed menses, prolonged flow and "spotting" were often so severe that it became necessary to stop the treatment. In a small series of cases, others reported good (8, 9) and bad (10, 11) results following estrogen therapy. A new synthetic estrogen, TACE, has been given therapeutic trial in a number of patients suffering from acne. TACE differs from other commonly used estrogens in several respects. After oral administration it is stored in the body fat from which it is released slowly over a period of time (12, 13). In experimental animals, the administration of other estrogens has been shown to produce hyperplasia of the adrenals, but following TACE this effect is minimal (13, 14). This is of some importance in the treatment of acne, a condition in which a relative excess of androgenic steroids is considered to be an important causal factor. In addition, the use of TACE is reported to produce very few undesirable side effects