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Acne / Birth Control PillFor some female patients, treatment-resistant acne is caused by excessive production of hormones called androgens. With extra androgens in your system, your oil-producing glands go into high gear — and so does your
acne. Several clues can help your doctor identify acne that may be influenced by hormones: acne that appears in adults for the first time;
acne flare-ups preceding the menstrual cycle; irregular menstrual cycles; hirsutism (excessive growth of hair or hair in unusual places); and elevated levels of certain androgens in the blood stream.
Adult women and teenage girls whose acne has resisted treatment with antibiotics or topical retinoids may be candidates for hormonal therapy. Once a patient’s acne is identified as hormonally influenced, the doctor will be able to prescribe a number of different therapies, or perhaps a combination of several different drugs; "combination therapy" is often the best approach to this kind of acne. Following are a few common components of therapy for
hormonal acne, but remember to consult your doctor before using any of the remedies listed here.
Acne / Birth Control Pill - Oral contraceptives. Birth-control pills (a combination of estrogen and progestin taken orally) are often prescribed for
hormonal acne. Low doses of estrogen help suppress the androgens produced by the ovaries, and the newer progestin agents, including desogestrel and norgestimate, are less androgenic than those found in older formulations. While only Ortho Tri-Cyclen and Estro-Step are currently approved by the FDA for this indication, experts agree that low-dose contraceptives improve acne regardless of which formula is used. Consult your gynecologist to find the formula that’s right for you. While side effects are uncommon, some women may experience brownish blotches, or melasma (hyperpigmentation) on the skin. These can be treated with topical bleaching agents.
Acne / Birth Control Pill - Anti-androgens. In combination with oral contraceptives, doctors also may prescribe an anti-androgen ; these drugs inhibit androgen production in the ovaries and adrenal glands and help prevent existing androgens from causing excessive oil production. Spironolactone, a high blood pressure medicine with anti-androgenic properties, has proven quite effective in the treatment of acne. Side effects may include breast tenderness, menstrual irregularities (in women not using oral contraceptives), headache and fatigue; since it's also a diuretic, you may experience frequent urination as well.
NOTE: Spiranolactone is tetrogenic and can cause feminization of a male fetus. If you are sexually active and not taking “the pill,” it’s imperative that you use another form of birth control.
Acne / Birth Control Pill - Corticosteroids. Small doses of corticosteroids, like prednisone or dexamethasone, may curb inflammation and suppress the androgens produced by the adrenal glands. Keep in mind that in some acne sufferers, corticosteroids may actually aggravate acne; they’re most effective when used in combination with oral contraceptives.
In
conclusion, if you think your acne is hormonally induced, see your
doctor right away. While this kind of acne requires a different
course of treatment, it is highly treatable. More about your hormones. |
Contributing Doctor
Dr. Risa Kagan
A board certified obstetrician-gynecologist. She is in a private practice in Berkeley, CA, and is an associate clinical professor at UCSF. Dr. Kagen specializes in gynecology with particular focus on advanced gynecologic surgery and women’s health care issues such as menopause and osteoporosis. She is co-medical director of the Foundation for Osteoporosis Research and Education (FORE) through which she is involved in several clinical research trials. Dr. Kagan lectures and teaches both lay audiences and professionals about women’s health. She has appeared on numerous television and radio programs talking about women’s health issues. |
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* Model images are for illustrative purposes only.
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