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Hormonal Treatment Guide (Acne)
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Hormonal Treatment Guide

Jerry K. L. Tan, MD FRCP

Hormonal treatments and oral contraceptives have been recognized by dermatologists for their effectiveness in treating women who have acne, regardless of severity. Acne is thought to result from masculinising hormones called androgens, which can have an effect on oil glands, which during puberty, often become sensitive and enlarge themselves. This can result in excessive oil production, blocking the pores, which then leads to the production of acne. Once acne bacteria proliferates the area, the pores can become inflamed, making visible pimples, pustules, and lumps.

The premise of hormonal treatment is in containing the levels of androgens, which starts the sequence that eventually leads to acne. There are options for both oral contraceptives such as Alesse®, Diane-35®, Tri-Cyclen® or Yasmin®, and non-contraceptive anti-androgens such as spironolactone. For more information on hormonal treatments for acne, read Other Hormone Therapy.

Polycystic ovarian syndrome affects 5 to 10% of women during their reproductive years, and is characterized by the development of acne, excessive body and facial hair, escalated blood insulin levels, obesity, and sometimes infertility. This condition affects women with high levels of androgen and testosterone. Blood tests and proper clinical evaluation can help diagnose this disorder, and hormonal therapy, in conjunction with proper exercise and weight control, can also help this condition.

Oral contraceptives which contain estrogens and progestins, work by reducing the levels of androgen produced by the body. Estrogen improves acne by decreasing production of adrenal and ovarian androgens, reducing DHT, and reducing levels of testosterone. Progestins, are more variable in their effect on androgen levels, and for the purpose of acne treatment, ones with low androgenic activity, such as desogestrel or norgestimate, are recommended. Cyproterone can also be combined with estrogen components as an alternative treatment.

Currently available oral contraceptives such as Alesse®, Diane-35®, Tri-Cyclen® and Yasmin® contain progestins with low androgenic activity, and provide women with acne, an important option for acne treatment. They have been proven to be safe, providing primary or secondary treatment in conjunction with topical treatments, or as supplementary treatments to systemic isotretinoin for scarring and inflammatory acne.

Minor side-effects can occur with all contraceptives. These can include breast tenderness, headache, and nausea, but tend to be mild, and are often resolved over continued usage. Their positive effects, on acne are well documented, with clinical studies on acne patients treated with Alesse and Tricyclen showing 40 to 50% reduction of acne spots over 6 months. 

Spironolactone is a synthetic steroid and an anti-androgen that reduces androgen biosynthesis, and blocks androgens from binding with the cell receptors. Although further studies are needed, there is some available evidence that the use of spironolactone has been effective in acne treatment.

For other treatment options, read Understand Your Acne Treatment Options.

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acne,   hormonal treatments,