A complex clinical and laboratory examination of 111 infertile patients with acne, including assessment of dermatological and gynecological status, hormonal profile, psychoemotional state, quality of life compared with 40 fertile women with acne and 33 patients with infertility and intact skin was performed. The contribution of the most significant factors leading to acne is assessed. First of all, hyperandrogenism, which develops as a result of hormonal imbalance, provoked by reproductive pathology (polycystic ovary syndrome – 27,9 %, hypothalamic-pituitary dysfunction – 6,3 %, hypo- or hyperthyroidism – 6,3 %, obesity – 25,2 %; the hereditary predisposition (55,9 %), the effect of provoking factors (smoking – 62,1 %, stress – 69,4 %, hypodynamia – 46,3 %, occupational hazards – 17,5 % etc.) make a significant contribution to the occurrence of acne in infertile women.
Clinical features of acne in this category of women have been established: development of acne tarda, localization of elements of the rash mainly in the U-zone, prevalence of inflammatory elements in the form of papules (76,8 %), lower incidence of open (56,1 %) and closed (48,7 %) comedones, a high incidence of post-acne formation (hyperpigmentation – 64,9 %, atrophic scars – 65,8 %, stagnant spots – 50,0 % etc.); a high prevalence of the process in severe forms ((5,5±0,9) zones); prevalence of moderate and severe forms of the disease (76,8 %), in contrast to fertile women with acne. The hormonal status of patients with acne and infertility was assessed depending on the form of infertility, hormonal imbalance (an increase in testosterone and luteinizing hormone levels in 28,8 %, follicle stimulating hormone in 14,4 % and dehydroepiandrosterone sulfate in 7,2 %) was revealed. Hormonal imbalance was clinically reflected as a syndrome of hyperandrogenism (hirsutism – 19,8 %, androgenic alopecia – 18,0 %, menstrual dysfunction – 58,6 %, infertility – 100 %) in 43,2 % of women.
The comorbidity of acne and infertility with disorders of the psychoemotional sphere was revealed. The character of psychoemotional disorders developing in patients with reproductive disorders is correlated with the severity of acne and its form. They manifested themselves in the form of clinically expressed anxiety-depressive disorders (more than 11 points on the HADS scale), mostly of a combined nature. They had the highest degree of severity with nodose and conglobate forms. An association of quality of life indicators and psychosocial effects of acne with psychoemotional disorders has been established. The quality of life of women with a violation of reproductive function, depending on the severity of acne, as well as its clinical and morphological form has been studied: the dependence of its severity on the severity of dermatosis has been established. The strong psychological and social influence of acne on the mood, self-esteem and daily activity of women with infertility (according to the DLQI scale – (13,3±6,2) points and (87,8±28,1) on the APSEA scale) is correlated with the severity of dermatosis (APSEA – ρ=0,31 and DLQI – ρ=0,27) and its clinical and morphological form, which led to their social disadaptation.
Based on the interdisciplinary approach, the clinical route of the infertile patient with acne has been developed and tested. Its effectiveness was proved: 59,4 % had stabilization, 40,6 % had an improvement in the clinical picture of acne, a 41,5 % decrease in the number of patients with psychoemotional disorders and a decrease in the quality of life (according to the DLQI scale from 99,1 % to 18,8 %, APSEA scale – from 79,5 % to 17,1 %), as well as a decrease in their severity (according to the HADS scale up to (6,9±1,9) points) and the impact on daily life (according to the DLQI scale to (5,2±1,7) points, according to the APSEA scale – up to (34,3±6,5) points). The effectiveness of the clinical route of the patient with acne and infertility was ensured by the achievement of compliance and continuity between specialists of different profiles (first of all, gynecologist, psychotherapist, endocrinologist) taking part in the treatment of this category of patients, with the obligatory coordinating role of the dermatovenerologist.
