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  • Presentation

Use of Oral Contraceptives for Acne

Description

The presentation discusses the use of combined oral contraceptives (COCs) as a treatment for acne in women, particularly those with hormone-driven acne related to conditions like polycystic ovary syndrome (PCOS). COCs are noted for their anti-androgenic properties, which can help manage acne by suppressing ovarian androgen production and increasing sex hormone-binding globulin. The speaker emphasizes that while all COCs are effective, those specifically FDA-approved for acne treatment include norethindrone, norgestimate, and drospirenone. They serve as a viable alternative to antibiotics, often reducing reliance on them for long-term acne management. Despite some past concerns about the risk of blood clots associated with drospirenone, recent studies have shown it does not pose a greater risk than other COCs. The presentation also highlights the importance of patient-centered decision-making when prescribing COCs, as there can be significant variability in patient preferences and values regarding contraceptive use. The overall conclusion is that COCs are a safe, effective option for treating acne in women, particularly for those seeking both acne treatment and contraception.

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Conclusions

  • Hormonal therapies, especially combined oral contraceptive pills (cOCPs), are effective in treating acne in female patients, particularly those with hormonal influences like polycystic ovary syndrome (PCOS).
  • cOCPs have similar efficacy to oral antibiotics for acne treatment, becoming comparable in effectiveness after six months of use, allowing for reduction in long-term antibiotic use.
  • The net effect of all cOCPs is antiandrogenic due to the estrogen component, which mitigates the androgenic effects of the progestin.
  • The efficacy of cOCPs is supported by moderate certainty evidence, with no significant differences between different formulations or doses.
  • Patient-centered prescribing and shared decision making are vital when prescribing cOCPs due to individual risks and preferences.
  • There are contraindications to cOCPs including pregnancy, certain health conditions, and risk factors for thromboembolism.
  • Drospirenone, a progestin found in some cOCPs, does not have a higher risk of thrombosis compared to third-generation contraceptive options.
  • While cOCPs are effective for treating acne, they can also provide benefits like menstrual regulation and a reduced risk for several cancers.
  • The risks associated with cOCPs, while present, are low compared to the risks associated with pregnancy.
  • Arowojolu A, Adekunle AO, Mehaisen MA, et al., Cochrane Database Syst Rev 2012. Combined oral contraceptives for acne. Cochrane Database Syst Rev. 2012;8:CD005671.
  • Koo JY, et al. J Am Acad Dermatol 2014;71:450-9. Meta-analysis of oral antibiotics versus combined oral contraceptives for acne treatment.
  • Biene E, et al. Am J Clin Dermatol 2018;19:449-455. The Use of Hormonal Antiandrogen Therapy in Female Patients with Acne: A 10-Year Retrospective Study.
  • deBastos M et al., Cochrane Database Syst Rev 2014 Mar 3;3. Combined oral contraceptive for treatment of acne.
  • Reynolds RV et al., JAAD 2023. Acne Guidelines.
  • Morch LS et al., NEJM 2017;377:2228-39. OCP and risks.
  • Roura E et al., PLoS One 2016;11:e0147029. OCP and health risks.
  • Maguire K and Westhoff C. Am J Obstet Gynecol., 2011. OCP benefits.