Second to fourth digit ratio in female patients with acne vulgaris: Could it be a predictor of androgen receptor status?

Background: Second to fourth digit (2D:4D) ratio is the ratio of index to ring fingers length. It reflects prenatal androgen exposure and sensitivity. Androgens are important in the pathogenesis of acne vulgaris, This ratio may therefore be of significance in determining the expression of androgen r...

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Published in:Indian journal of dermatology, venereology, and leprology venereology, and leprology, 2019-11, Vol.85 (6), p.590-596
Main Authors: Farag, Azza, Shoiab, Mohamed, Samaka, Rehab, Abdou, Asmaa, Elnaidany, Nada, Mansour, Asmhan
Format: Article
Language:English
Subjects:
Acne
Acne Vulgaris - diagnosis
Acne Vulgaris - metabolism
Adolescent
Adult
Androgen receptors
Androgens
Biopsy
Care and treatment
Cross-Sectional Studies
Family medical history
Female
Females
Fingers - pathology
Genes
Genetic aspects
Growth factors
Health aspects
Humans
Ligands
Medical research
Pathogenesis
Patients
Predictive Value of Tests
Pregnant women
Receptors, Androgen - metabolism
Sex hormones
Statistical analysis
Women patients
Women's health
Young Adult
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Summary:Background: Second to fourth digit (2D:4D) ratio is the ratio of index to ring fingers length. It reflects prenatal androgen exposure and sensitivity. Androgens are important in the pathogenesis of acne vulgaris, This ratio may therefore be of significance in determining the expression of androgen receptors. Aim: To investigate the relationship between second to fourth digit ratio and androgen receptor expression in female patients with acne vulgaris and to assess its association with clinical aspects of acne vulgaris. Methods: Females patients (n = 352) with different degrees of acne vulgaris severity and 168 age-matched females were enrolled. Right, left and total second to fourth digit ratios were calculated. Biopsies from all participants were processed for androgen receptor expression by immunohistochemical method. Results: Right, left and total second to fourth digit ratios were significantly lower in acne vulgaris patients than controls (P < 0.001 for all), and each of them had a significant negative correlation with duration of acne vulgaris (P < 0.001; P = 0.013; P < 0.001, respectively). Androgen receptors were detected in epidermal keratinocytes, hair follicles, sebaceous glands and fibroblasts. Right second to fourth digit ratio showed a negative correlation with androgen receptor H score of keratinocytes (r = −0.28;P = 0.02), hair follicles (r = −0.22; P = 0.05) and fibroblasts (r= −0.37;P = 0.001), while left second to fourth digit ratio demonstrated negative correlation with androgen receptor H score of sebocytes (r = −0.397; P < 0.000) only. Limitations: Lack of follow-up and absence of male participants were the main limitations of this study. Conclusion: A masculine second to fourth digit ratio in female patients could anticipate acne vulgaris development, its duration and severity. Moreover, this ratio is associated with an upregulation of cutaneous androgen receptors. Taken together, second to fourth digit ratio could help in designing plans for treatment of acne vulgaris.
ISSN:0378-6323
0973-3922
1998-3611
DOI:10.4103/ijdvl.ijdvl_35_18