Oral Contraception and the Treatment of Acne: Current Perspectives

In the document from July 2002, Serge Bélisle, MD, MSc, discusses the role of oral contraceptives in the treatment of acne, particularly in the context of hyperandrogenism, which affects 5% to 7% of women of reproductive age and is the most prevalent endocrine dysfunction in this group. Acne is a common symptom of hyperandrogenism, affecting 80% of adolescent girls and over 12% of women aged 25 or older. The treatment strategies for acne include comedolytics, antimicrobials, and reduction in sebum production, with oral contraceptives being used to reduce sebum production by lowering androgen production and increasing sex hormone-binding globulin. The document highlights that most oral contraceptives improve acne and hirsutism, with those containing cyproterone acetate showing a higher rate of regression in severe cases. However, the majority of studies are case series or open-ended investigations, with few randomized placebo-controlled studies. The use of antibiotics in combination with oral contraceptives does not affect their efficacy or safety. The conclusion is that oral contraceptives are clearly indicated for the treatment of androgen-excess syndromes like acne and hirsutism, and most prescribed formulations will improve mild to moderate forms, while those with CPA are effective for more severe cases. Safety and efficacy are maintained with the concurrent use of antibiotics.