Oral contraceptive pills and antiandrogens for the treatment of acne vulgaris
In certain cases hormonal therapies may be helpful in the treatment of acne. The use of oral contraceptive pills (OCP) can lead to a decrease in circulating free testosterone, a decrease in sebum production, and an improvement in acne. An OCP formulation with a progestin with low androgenic potential is desired, such as norgestimate, desogestrel or drospirenone. Commonly used OCPs for acne are Ortho Tri-cyclen, YAZ and Beyaz. The FDA is currently reviewing whether there is an increased risk of blood clot formation with the use of drospirenone-containing OCPs. See: http://www.fda.gov/Drugs/DrugSafety/ucm273021.htm
Clues to hormonal acne include:
- Acne lesions concentrated in the lower one-third of the face, including the jawline and upper neck.
- Increase in painful nodules versus comedones.
- Acne flares in the week or so prior to menstruation.
Patients must be screened and counseled prior to receiving OCPs for the treatment of acne. A medical history should be obtained including presence or history of high blood pressure, smoking, stroke, blood clots, liver tumors, liver disease, breast cancer, abnormal vaginal bleeding, and current pregnancy or nursing. Family history should be reviewed for a history of blood clots or stroke, breast or ovarian cancer, and liver disease.
The drug spironolactone can also be useful in the treatment of acne vulgaris, and can be used alone or added to an OCP. Spironolactone both binds androgen receptors and reduces androgen production. However, use of spironolactone may result in a number of adverse side effects, such as dizziness, breast tenderness, and menstral abnormalities. Potassium levels must be monitored, and blood pressure checked periodically. Spironolactone cannot be used during pregnancy. The OCPs YAZ and Yasmin contain drospirenone, which is a spironolactone derivative.
The use of an OCP or anti-androgen should be evaluated for 3 to 6 months to see efficacy.
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