Which birth control (contraceptive) medications are approved for the treatment of acne?

From the Guidelines

The FDA has approved four combination oral contraceptives (COCs) for the treatment of acne in women who desire oral contraception, including norgestimate/EE, norethindrone acetate/EE/ferrous fumarate, drospirenone/EE, and drospirenone/EE/levomefolate, as they have been shown to reduce acne by decreasing the production of androgens and sebum production 1. These medications contain both estrogen and progestin, which work together to reduce acne by decreasing the production of androgens (male hormones) that stimulate oil glands in the skin.

• The estrogen component, typically ethinyl estradiol (EE), reduces the conversion of testosterone to dihydrotestosterone in the pilosebaceous unit, further decreasing sebum production.
• The progestin component, such as drospirenone, has antiandrogenic properties, which help to reduce acne.
• These contraceptives typically take about 2-3 months of consistent use before significant improvement in the skin is noticed.
• It is essential to consult with a healthcare provider before starting any hormonal treatment for acne, as they can help determine if birth control is appropriate based on medical history and specific skin concerns.
• The pills must be taken daily at approximately the same time for maximum effectiveness, both for acne treatment and pregnancy prevention.
• While these medications can be effective for many women with hormonal acne, they may cause side effects such as nausea, breast tenderness, or headaches, particularly during the first few months of use 1.

From the FDA Drug Label

1.3 Acne Drospirenone and ethinyl estradiol tablets are indicated for the treatment of moderate acne vulgaris in women at least 14 years of age, who have no known contraindications to oral contraceptive therapy and have achieved menarche. Drospirenone and ethinyl estradiol tablets should be used for the treatment of acne only if the patient desires an oral contraceptive for birth control.

The birth control approved for acne treatment is drospirenone and ethinyl estradiol tablets.

• Key points:
  • Indicated for moderate acne vulgaris
  • For women at least 14 years of age
  • Should be used for acne treatment only if the patient desires an oral contraceptive for birth control 2 2

From the Research

Approved Birth Control for Acne Treatment

The following birth control methods are approved for acne treatment:

• Combination oral contraceptive pills (COCs) containing estrogen and progestin, such as Tricyclen and Diane-35, which have been shown to reduce acne lesions by lowering androgen levels and inhibiting 5-alpha-reductase 3
• Drospirenone-containing oral contraceptives, such as Yasmin and Yaz, which have antiandrogenic properties and have been demonstrated to be effective in reducing acne lesions 4, 5
• Combined oral contraceptives containing new-generation progestogens, such as desogestrel and gestodene, or progestational antiandrogens, such as cyproterone acetate and chlormadinone acetate, which have been shown to be effective in treating acne 6

Mechanism of Action

These birth control methods work by:

• Reducing androgen levels, which contribute to acne development
• Increasing estrogen levels, which can help reduce sebum production and acne lesions
• Inhibiting 5-alpha-reductase, which reduces the levels of dihydrotestosterone and subsequently reduces acne lesions
• Stimulating sex hormone-binding globulin (SHBG), which reduces the levels of free testosterone and subsequently reduces acne lesions 7, 3

Candidate Patients

The following patients may be candidates for birth control as a treatment for acne:

• Women with moderate acne vulgaris who seek contraception
• Teenagers with acne who refuse antibiotics or in whom topical antibiotics are ineffective
• Women with scarring and severe inflammatory acne being treated with systemic isotretinoin, for whom birth control is one of two preferred methods of contraception 3, 4