Impact of systemic hormonal imbalances on sebaceous gland disorders: An in-depth review integrating clinical, endocrine, and therapeutic insights

Sebaceous gland disorders (SGDs), including acne vulgaris, seborrheic dermatitis, sebaceous hyperplasia, and hidradenitis suppurativa, are strongly influenced by systemic hormonal regulation. Androgens, insulin, insulin-like growth factor-1 (IGF-1), estrogens, and progesterone modulate sebocyte proliferation, differentiation, and sebum production. Androgens, particularly dihydrotestosterone, are key drivers of sebaceous activity, while insulin and IGF-1 promote lipogenesis via sterol regulatory element-binding protein-1 activation. Estrogens generally inhibit sebaceous function, whereas progesterone may increase sebaceous output under certain conditions. Endocrine disorders such as polycystic ovary syndrome, congenital adrenal hyperplasia, Cushing’s syndrome, and thyroid dysfunction commonly present with characteristic sebaceous changes, underscoring the diagnostic value of cutaneous findings as markers of systemic disease. Persistent acne and seborrhea are frequently linked to hyperandrogenism and insulin resistance, particularly in polycystic ovary syndrome (PCOS), while cortisol and thyroid hormone alterations affect skin oiliness, texture, and inflammation. Management increasingly emphasizes hormonal and metabolic modulation alongside dermatologic therapy, with combined oral contraceptives, spironolactone, metformin, hormone replacement therapy, and targeted lifestyle interventions showing benefit. Emerging evidence also implicates prolactin in cutaneous physiology, galectin-12 as a potential biomarker of sebaceous activity, and endocrine-disrupting chemicals in disease pathogenesis. Overall, SGDs serve as important dermatologic indicators of hormonal imbalance. This review uniquely integrates endocrine, metabolic, and dermatologic perspectives to comprehensively elucidate the mechanisms, clinical manifestations, and therapeutic strategies of sebaceous gland disorders, while proposing a multidisciplinary framework for improved diagnosis and long-term patient outcomes.