Hormonal Therapy for Acne: Why Not as First Line Therapy? Facts and Controversies

The document from 2010 examines the effectiveness and considerations of hormonal therapy as a treatment for acne, particularly in women. It suggests that hormonal treatments, including antiandrogens and combination oral contraceptives (OCs), can be effective by reducing androgen levels, which play a significant role in acne development. Indications for hormonal therapy include hyperandrogenism, persistent acne, acne unresponsive to isotretinoin, late-onset acne, polycystic ovary syndrome (PCOS), and signs of hyperandrogenism. While hormonal therapy can be beneficial, it is not typically used as first-line therapy due to potential side effects, contraindications, and the importance of patient selection. The document also dispels misconceptions about OCs, such as causing weight gain, and suggests that hormonal therapies should be considered in the treatment of acne, especially with new formulations and guidelines.