How oral contraceptives can be used to treat acne

Androgenic skin disorders occur in some women after menarche and are associated with acne, excessive facial oiliness and hirsuitism (hairiness). Professional women aged 20-40 tend to have stubborn acne mainly on the chin and forehead, possibly due to stress induced androgen secretion by the adrenal glands. Such women tend to have a negative body image, lose confidence, feel unattractive and unkept. Thus acne tends to disrupt feminine socio-psychological well being, especially since persistent acne can produce residual scars. These lesions are tough to eradicate unless the root cause is removed.

Androgens play a central role in the development of acne by increasing sebum secretion, increasing sebaceous gland size and promoting follicular hyperkeratinization. Thus in order to eradicate acne due to androgens, therapy must be directed towards counteracting its effects. This can be achieved by agents suppressing androgen production, i.e. oral contraceptives and androgen receptor blockers such as spironolactone or cyproterone acetate. Estrogens found in oral contraceptives can reduce acne by reducing androgen hormone production from the ovaries and adrenal glands and increasing sex hormone binding globulin (SHBG) production. SHBG counteracts androgen activity. There are several forms of estrogens available in the form of oral contraceptive pills.

Oral Contraceptives in Acne Reduction

Many oral contraceptives contain an estrogen and a progestin. Almost all oral contraceptives prevent the ovarian production of androgens by suppressing ovulation which leads to low serum androgen levels and reduction in sebum secretion and thereby treating acne effectively. Administering oral contraceptives should be done according to the individual requirements of women.

The efficacy of a particular oral contraceptive in treating acne depends on its estrogen-progestin balance. Progestins cause alteration in lipid profiles and increase in serum glucose and interfere with the beneficial effects of estrogen on promoting sex hormone binding globulin (SHBG). So when estrogen doses are higher than the progestin doses in a particular oral contraceptive, it usually helps to reduce acne. Whereas the opposite causes acne to worse or even flare up in women who have never experienced this condition before.

Indications

1) Women who are not responding to other standard acne treatments
2) Women with severe sebum secretion
3) Acne beginning during adulthood and worsening before menstruation.

Ideal OC pills to choose

The progestin to be used should be selected with care plus the absolute dose of estrogen and progestin should be kept in mind while choosing the correct oral contraceptive.

1) Ethinylestradol/cyproterone acetate known commonly as Diane 35 and Dianette is the best established and most effective of the combined oral contraceptives in treating androgenic related acne. This is a gold standard hormonal therapy for acne, since it is effective in mild and severe cases, reducing inflammatory lesions in up to 75% cases.
2) Alternatives include using the popular oral contraceptive Triphasil which contains ethinyl estradiol and levonorgestrel. Its been shown to reduce 75% of non-inflammatory comedones and about 50% of inflammatory lesions.
3) Ortho Tri-Cyclen, containing ethinyl estradoil and norgestimate, significantly improved papopustular lesions up to 60% and brought about a decrease in lesion count after just 6 months of treatment.
4) Alesse, consisting of ethinyl estradiol and levonorgestrel, there is reduction of the inflammatory lesion count up to 47%.
5) Estrostep which contains norethindrone, lessens lesion counts by 47%.
6) Third generation progestins such as desogestrel, norgestimate, or gestodene are preferred as they have the lowest androgenic activity.
7) Drospirenone, a new progestin is ideal for androgenic acne since it has strong anti-androgenic properties. DRSP along with estrogen is found in the brand name contraceptive called “Yasmin” made by Berlex Laboratories in the USA. Yasmin (ethinyl estradiol combined with drospirenone) is as effective as Diane -35 in acne reduction in some studies.

Side effects

1) Typical side effects include headaches, breast tenderness, leg edema and weight gain.
2) Rarely, oral contraceptive pills are associated with thromboembolism, i.e. blood clots in the legs that become life threatening if the blood clots break off in the veins and float up into and clog the heart and lungs.

Thus in adult women with persistent acne associated with stress, oral contraceptives can prove to be ideal with its dual effects of acne treatment and contraception. The oral contraceptives that are approved for use in the U.S are Ortho Tri-Cyclen and Estrostep.