Endocrinological Evaluation and Hormonal Therapy for Women with Difficult Acne

In December 2001, Diane M. Thiboutot's study discussed hormonal therapy as an alternative treatment for women with severe acne unresponsive to conventional treatments, particularly when there is suspicion of endocrine abnormalities. The paper recommended an endocrine evaluation to check for androgen levels and suggested various hormonal therapies, including androgen receptor blockers, adrenal androgen production blockers, ovarian androgen blockers, and oral contraceptives (OCs) containing estrogen and progestin. Two large studies involving approximately 500 women showed that Ortho Tri-Cyclen, an OC with ethinyl estradiol and norgestimate, improved acne. Concerns about OC efficacy reduction due to antibiotic interaction were considered mostly theoretical. The study also indicated that future treatments could include enzyme inhibitors targeting local androgen production in the skin, but more research is needed. Hormonal therapy was deemed effective even when serum androgen levels were normal but at the high end of the normal range.