Drug update: systemic acne treatments for women

OB/GYN News, August 1, 2002 by Mitchel L. Zoler, Heidi Splete

The road to clear skin is getting shorter. Recent Food and Drug Administration approval of several oral contraceptives for the treatment of mild to moderate acne has expanded the systemic treatment options for women. In addition, a flurry of direct-to-consumer advertising may send more women to their primary care physicians or gynecologists seeking prescriptions for acne medications.

As dermatologists know and primary care physicians are learning, acne is prevalent among adults, especially women. Women are becoming increasingly aware of their treatment options and are actively seeking them rather than hoping that the condition will resolve on its own. Physicians can treat adult acne with oral or topical agents, or a combination of both, but it's important 5 tailor treatment to the patient's type of acne. Oral contraceptives and antibiotics are good for inflammatory acne. Oral or topical retinoids, such as isotretinoin, are best for treating severe nodular acne. Treatment should also be dictated by severity; no treatment protocol is best for everyone.

All drugs listed should be avoided during pregnancy and by women who are breast-feeding. Women aged 35 or older who smoke should not take oral contraceptives.

ORAL CONTRACEPTIVES

This class treats inflammatory acne on a hormonal level by reducing androgen production and circulating androgens. Some study results have shown increased levels of androgens in women with acne, but the exact relationship between acne and the menstrual cycle remains elusive. Many women with acne also have hyperandrogenic symptoms, such as irregular periods, oily skin, and mild hirsutism.

OCs can be effective for mild to moderate acne but are often ineffective for more severe cases. They're a good choice for women with mild to moderate acne who also want contraception. Daily use is necessary. Some OCs have been specifically tested and approved for treating acne, while others have not. Some oral contraceptives, those with larger androgen doses, are bad for acne. All three OCs listed are equally safe and have not been tested head-to-head. Hormonal manipulation helps resolve the acne but also causes many side effects, so an element of trial and error is involved. Limit side effects by cutting the estrogen dose. A patient with bloating or nausea may find a lower dose more tolerable; a patient with breakthrough bleeding may need a higher dose. Other oral contraceptives probably have similar safety and efficacy, but physicians may feel more comfortable prescribing one with FDA approval for acne. If used with one of the antibiotics listed below, advise a second method of birth control because of concern that antibiotics may negate estrogen's contraceptive effect.