Acne and ‘Mild’ Adrenal Hyperplasia

with no other clinical manifestations of CAH. In a recently published paper [6] , the authors postulate that there appears to be enough evidence to screen for the presence of nonclassical CAH in healthy young men presenting with acne as the sole clinical feature, as this may represent an indication for an inhibitory therapy with exogenous corticoids. However, while this concept appears appealing at first sight, it is fraught with some serious problems and inconsistencies. That patients with acne of various degrees of severity had significantly higher plasma levels of 17-OH-progesterone with regard to controls [6] was already described 20 years ago in men with cystic acne [7] , whereas no changes in 17-OH-progesterone levels were found in men with persistent acne vulgaris [8] . No correlation was found between the circulating levels of adrenal steroid precursors and the severity of acne, thereby weakening the case for a causal link [6] . The interpretation of the circulating hormone levels is also problematic. The authors performed an adrenocorticotrophic hormone (ACTH) stimulation test in patients suffering from acne and describe a surprisingly high prevalence of over 12% of CAH by using unconventional diagnostic criteria. Most specialists agree that the diagnosis of classical or nonclassical CAH is established when the circulating levels of 17-OH-progesterone after an ACTH stimulation test exceed 10,000 ng/dl or lie between 1,000 and 10,000, respectively, whereas values of