From the Guidelines
Combined oral contraceptives (COCs) containing both estrogen and progestin, such as those with ethinyl estradiol combined with norgestimate, norethindrone acetate, or drospirenone, are the most effective birth control options for improving acne, as supported by the most recent evidence from 2024 1. The benefits of COCs for acne treatment include:
- Reducing androgen levels
- Decreasing sebum production
- Reducing inflammation Recommended options include:
- Ortho Tri-Cyclen (ethinyl estradiol + norgestimate)
- Estrostep Fe (ethinyl estradiol + norethindrone acetate)
- Yaz (ethinyl estradiol + drospirenone) These should be taken daily as directed, typically for at least 3-6 months to see maximum acne improvement, as suggested by the 2019 study 1. It's essential to note that while COCs can significantly improve acne, they may not be suitable for everyone due to potential side effects or contraindications, and a healthcare provider should be consulted to determine the most appropriate option based on individual health history and needs, as emphasized in the 2024 guidelines 1. The use of progestin-only contraceptives, on the other hand, may worsen acne, as reported in both the 2019 study 1 and the 2024 guidelines 1. Therefore, COCs containing estrogen and progestin, such as those mentioned above, are the preferred choice for acne treatment in women who desire oral contraception, due to their anti-androgenic properties and ability to reduce acne symptoms, as supported by the latest evidence from 2024 1.
From the FDA Drug Label
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 contraceptive drospirenone and ethinyl estradiol tablets are beneficial for acne treatment, specifically 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, and who also desire an oral contraceptive for birth control 2, 2.
- Key points:
- Indication: Moderate acne vulgaris
- Age: At least 14 years old
- Additional requirement: No known contraindications to oral contraceptive therapy and has achieved menarche
- Concomitant use: For birth control purposes only
- Reference: 2, 2
From the Research
Beneficial Contraceptives for Acne Treatment
The following contraceptives have been found to be beneficial for acne treatment:
- Oral contraceptives (OCs) that contain an estrogen and a progestin, such as Tricyclen and Diane-35, which can reduce acne by lowering the production of adrenal and ovarian androgens 3
- Low-dose OCs, which have been shown to be effective in improving acne and have side effects similar to placebo 4
- Combination oral contraceptives (COCs) that contain a progestin such as levonorgestrel, norethindrone acetate, norgestimate, drospirenone, and dienogest, which have been found to reduce acne lesion counts and improve acne severity grades 5
- Drospirenone-containing OCs, which have been shown to minimize the potential negative effect of progestin on acne and are suitable for women with moderate acne vulgaris who seek contraception 6
Comparison of Contraceptives for Acne Treatment
Studies have compared the effectiveness of different contraceptives for acne treatment, including:
- COCs with different progestin types and dosages, which have been found to have varying effects on acne, with some being more effective than others 5
- Drospirenone, norgestimate, and desogestrel, which have been found to be more effective than levonorgestrel and norethindrone in improving acne 7
- Triphasic progestin dosage in COCs, which has been found to have a positive effect on acne, while variation in estrogen dose has not been found to have a significant effect 7
Patient-Reported Outcomes
A retrospective analysis of 2147 patients found that:
- Depot injections, subdermal implants, and hormonal intrauterine devices worsened acne on average, while the vaginal ring and COCs improved acne on average 7
- Within COC categories, a hierarchy emerged based on the progestin component, with drospirenone being the most helpful, followed by norgestimate and desogestrel, and then levonorgestrel and norethindrone 7