The Pill: Pimples, Pigmentation, and Alopecia?

The document from 1988 discusses the effects of oral contraceptives (OCs) on acne, hirsutism, alopecia, and pigmentation. It explains that OCs can either improve or induce acne and hirsutism, with improvement being more common. The estrogen in OCs increases testosterone-estrogen binding globulin, decreasing free testosterone levels and suppressing androgen synthesis, which reduces sebum secretion. In Australia, OCs contain levonorgestrel or norethisterone, which have androgenic properties, but the triphasic pill is less androgenic than the monophasic pill, reducing the incidence of acne from 11% to 0.4% as shown in a study evaluating 23,000 cycles. The biphasic pill is even more estrogenic and is preferred for women with acne or hirsutism. New treatments using ethinyl estradiol and cyproterone acetate have shown improvements in 95% of women with acne and 60% with hirsutism. Telogen effluvium, a form of diffuse hair loss, has been reported after stopping OCs but is self-limiting with hair returning to normal growth after 6 months. Pigmentation changes have been observed in some women on OCs, and while the mechanism is unclear, a low-dose hormone pill is recommended. The document also notes that there is conflicting evidence regarding the association between melanoma and OC use, suggesting that women with melanoma should avoid OCs until more information is available.