Oral Contraceptives as Anti-Androgenic Treatment of Acne

Oral contraceptives (OCs) have been found to be effective in causing significant regression of mild to moderate acne in women. This is due to their ability to decrease ovarian and adrenal androgen precursors, increase sex hormone-binding globulin (SHBG), and reduce the catabolite of dihydrotestosterone (DHT) in peripheral tissues. The estrogen-progestin combination containing cyproterone acetate (CPA) is particularly effective due to its direct anti-androgenic action. Spironolactone has shown some efficacy in treating acne, either alone or combined with OCs, in a few studies with small patient numbers. New non-steroidal anti-androgens like flutamide and finasteride are being evaluated for hirsutism treatment. Oral antibiotics are effective for inflammatory acne lesions and do not impair the contraceptive efficacy of OCs when taken together. However, a second contraceptive method is recommended in cases where OC absorption or efficacy might be compromised. Low-dose OCs, which have side effects similar to placebo, can be used alone or with other anti-acne agents, and physicians should consider multiple factors when prescribing OCs for acne. Patients with moderate to severe acne or those not responding to treatment should be referred to a dermatologist.