Foreword

In the 2011 supplement to the American Journal of Clinical Dermatology, the potential benefits of the combined oral contraceptive (OC) ethinylestradiol/chlormadinone acetate (EE/CMA) 0.03 mg/2 mg for treating disorders of the pilosebaceous unit (PSU) such as acne, female pattern hair loss (FPHL), hirsutism, and seborrhea were discussed. These conditions, often caused by androgen hyperactivity within the PSU, can lead to significant psychological distress. While EE/CMA is approved in Europe as a contraceptive and is being evaluated for acne treatment, there is also some evidence suggesting its beneficial effects on FPHL, hirsutism, and seborrhea. The review by Drs. Guerra-Tapia and Sancho Pérez from Complutense University in Madrid provided a comprehensive overview of the physiological and pharmacological mechanisms underlying these conditions, highlighting both current knowledge and gaps in understanding. The supplement included case reports suggesting that EE/CMA could be helpful in treating these PSU disorders, although no comparative studies were found for conditions other than acne. The foreword emphasized the importance of interdisciplinary cooperation between dermatologists and gynecologists in managing these conditions and the need for thorough work-up to rule out other causes before starting OC treatment. It also noted the challenges faced by clinicians practicing evidence-based medicine due to the lack of high-level evidence for certain treatments.