Should dermatologists prescribe hormonal contraceptives for acne?
Open accessAbstract
ABSTRACT One of the primary factors contributing to the development of acne vulgaris is excess sebum. Sebaceous glands and sebum excretion are regulated, at least in part, by androgen hormones. Acne treatments that block this androgen effect include spironolactone and combination oral contraceptives (COC). Three COC are now FDA approved to treat moderate acne. Dermatologists must become experts at prescribing these hormonal contraceptives. Likewise, it is vital to be aware of contraindications to hormonal contraceptive therapy. Proper patient selection relies on an appropriate medical history and an assessment of blood pressure. A pelvic exam and/or Papanicolaou smear are not required prior to initiating therapy with a COC. It is important to counsel patients about potential adverse effects of COC pills and to establish appropriate expectations concerning acne improvement.
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Combined oral contraceptive use is associated with small increases in myocardial infarction and stroke risks, particularly in patients over age 35 who smoke or who have hypertension, diabetes mellitus, or migraines.
“COC use is associated with small increases in myocardial infarction and stroke risks, particularly in patients above age 35 years who smoke tobacco or patients who have hypertension, diabetes mellitus, or migraines.”
From Guidelines of care for the management of acne vulgaris (2024) · cites this paper as [194]
The “Risks of combination oral contraceptive pills” section (page not provided) reports increased myocardial infarction and stroke risks associated with COC use and identifies smoking, age, hypertension, diabetes, and migraines as relevant risk factors. It does not characterize the increases in myocardial infarction or stroke risk as small, so that magnitude is unsupported. (LLM, conf=0.86)
Experimental — accuracy not yet measuredCombined oral contraceptives treat acne through anti-androgenic effects: they decrease ovarian androgen production, increase sex hormone-binding globulin, and reduce free testosterone that would activate the androgen receptor.
“COC treat acne through their overall anti-androgenic properties, which decrease ovarian androgen production, increase sex hormone-binding globulin, and reduce free testosterone that would otherwise activate the androgen receptor.”
From Guidelines of care for the management of acne vulgaris (2024) · cites this paper as [194]
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Guidelines of care for the management of acne vulgaris
Zaenglein, A. L., Pathy, A. L., Schlosser, B. J., Alikhan, A., Baldwin, H. E., Berson, D. S., Bowe, W. P., Graber, E. M., Harper, J. C., Kang, S., et al. (2016) · Journal of the American Academy of Dermatology · doi:10.1016/j.jaad.2015.12.037 · Cited by 1,597 · see citing works
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- Authors
- Harper, J. C.
- Affiliations
- University of Alabama at Birmingham (US)
- Corresponding author
- Harper, Julie C.
- ORCID
- Harper, Julie C.
- Venue
- Dermatologic Therapy
- Publisher
- Hindawi Limited
- Published
- 2009-09
- Volume
- 22
- Issue
- 5
- Pages
- 452-457
- ISSN
- 1396-0296 (ISSN-L)
- 1529-8019
- OpenAlex
- W2031361026
- Semantic Scholar
- 4feb448cf515a4ca4e26c27e81fb256a627b50c7
- Cited by
- 27
- References
- 33
- Citations by year
- 2024: 1 · 2023: 3 · 2022: 3 · 2020: 1 · 2019: 1 · 2018: 1 · 2017: 2 · 2016: 3 · 2015: 3 · 2014: 3 · 2012: 3
- FWCI
- 2.49
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Dermatologic Therapy (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Dermatology › Acne and Rosacea Treatments and Effects
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Health Sciences › Medicine › Dermatology › Dermatologic Treatments and Research
- Keywords
- acne, hormonal contraception, combined oral contraceptives, spironolactone, androgen regulation, sebum production, sebaceous glands, contraindications, patient selection, blood pressure measurement, adverse effects, patient counseling
- MeSH terms
- Acne Vulgaris, Contraceptives, Oral, Combined, Contraceptives, Oral, Hormonal, Dermatology, Female, Humans, Practice Patterns, Physicians', Sebum, United States, United States Food and Drug Administration, Drug Approval
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