Hormonal Therapies for Acne: A Comprehensive Update for Dermatologists

January 2025 in “ Dermatology and Therapy ”

Courtney Smith, Emily Gosnell, Turkan Banu Karatas, Chelsea Deitelzweig, E. Dale Collins, Howa Yeung

hormonal therapies combined oral contraceptives spironolactone clascoterone anti-androgen venous thromboembolism COCs

From the encyclopedia

Spironolactone →

powerful topical and oral anti-androgen used mostly by women

Clascoterone →

a novel topical treatment that inhibits DHT on androgen receptors

Studysummary This review updates dermatologists on both FDA-approved and off-label hormonal therapies, including combined oral contraceptives, clascoterone, and spironolactone, used for acne treatment, providing insights into emerging approaches for managing the condition.

Our plain-language summary. Not medical advice or a treatment recommendation. Consult a qualified healthcare professional before changing treatment. Full disclaimer

Hormonal therapies, such as combined oral contraceptives (COCs), spironolactone, and clascoterone, are effective in treating acne and improving quality of life. COCs are generally similar in efficacy and should be chosen based on patient preferences, though they carry a risk of venous thromboembolism. Spironolactone is recommended as a first-line treatment for women, with minimal need for potassium monitoring unless specific risk factors are present. Clascoterone is a safe topical anti-androgen effective for both men and women, with minimal systemic effects. The review encourages dermatologists to consider these therapies, engage in shared decision-making, and expand their use to men and pediatric patients to enhance treatment adherence and safety.

View this study on link.springer.com →

Discuss this study in the Community →

Research cited in this study

9 / 9 results

research Guidelines of Care for the Management of Acne Vulgaris

5 citations , January 2024 in “Journal of the American Academy of Dermatology”

This study provided 18 evidence-based recommendations for managing acne vulgaris, strongly endorsing treatments like benzoyl peroxide, topical retinoids, and oral isotretinoin for severe cases, and issued conditional recommendations for therapies like salicylic acid and spironolactone, while offering good practice statements on combining treatment methods.

research Correlations Between Hormonal Intrauterine Devices and Androgenic Skin Conditions: A Retrospective Cohort Study

2 citations , February 2022 in “Journal of The American Academy of Dermatology”

This study found that hormonal IUD implantation was associated with an increased risk of acne vulgaris but a decreased risk of hirsutism, alopecia, and rosacea compared to nonhormonal copper IUDs.

research Association of Spironolactone Use With Risk of Cancer: A Systematic Review and Meta-Analysis

13 citations , February 2022 in “JAMA Dermatology”

This meta-analysis found that spironolactone use was linked to a decreased risk of prostate cancer but not to a significant risk increase for several other cancers, although the evidence certainty was low.

research Trends in the Prescribing Pattern of Spironolactone for Acne and Hidradenitis Suppurativa in Adolescents

4 citations , December 2021 in “Journal of The American Academy of Dermatology”

This study reported a significant increase in the use of spironolactone for treating acne and hidradenitis suppurativa in female adolescents, noting a 2- to 3-fold rise in prescriptions and suggesting improved tolerance compared to adults, though its efficacy in adolescents is less pronounced.

research Dual Effects of 5α-Reductase Inhibitor Dutasteride on Androgenetic Alopecia and Acne Vulgaris

January 2019 in “Dermatologica Sinica”

This study observed that dutasteride treatment led to improvement in acne vulgaris among two male patients with androgenetic alopecia, suggesting its potential as a treatment option for concurrent conditions.

research A Review of Hormone-Based Therapies to Treat Adult Acne Vulgaris in Women

29 citations , March 2017 in “International Journal of Women's Dermatology”

This review found that combined oral contraceptives and spironolactone are effective treatments for adult acne in women, but noted that oral contraceptives increase the risk of venous thromboembolism and require individual risk assessment before use.

research Spironolactone for the Treatment of Acne: A 4-Year Retrospective Study

22 citations , January 2017 in “Dermatology”

In this retrospective study, spironolactone improved acne in 86% of patients while showing minimal side effects, suggesting it as a safe treatment option for postadolescent acne with a low risk of short-term adverse effects like hyperkalemia.

research Adverse Effects and Safety of 5-Alpha Reductase Inhibitors (Finasteride, Dutasteride): A Systematic Review

32 citations , July 2016 in “PubMed”

This review discusses the adverse events associated with 5-alpha reductase inhibitors, finding them generally well-tolerated but noting potential risks like sexual side effects and psychological effects in men, and sparse data on use in women.

research Efficacy of an Oral Contraceptive Containing EE 0.03 mg and CMA 2 mg (Belara) in Moderate Acne Resolution: A Randomized, Double-Blind, Placebo-Controlled Phase III Trial

42 citations , May 2009 in “Contraception”

This study found that the combined oral contraceptive containing ethinyl estradiol and chlormadinone acetate was effective in reducing moderate papulopustular acne and other androgen-related skin disorders compared to placebo.