What is the best oral contraceptive (OC) for treating hormonal acne?

From the Guidelines

For treating hormonal acne, the best oral contraceptive is Yaz (containing ethinyl estradiol 20mcg and drospirenone 3mg), due to its strong anti-androgenic properties that help reduce sebum production and acne formation. This recommendation is based on the most recent and highest quality study available, which suggests that combined oral contraceptives (COCs) containing estrogen and an anti-androgenic progestin are typically most effective for treating hormonal acne 1. Drospirenone, a fourth-generation progestin, has antiandrogenic properties that make it particularly effective in reducing acne formation.

Key Points to Consider

• COCs work by reducing androgen levels and activity, which decreases oil production in the skin 1.
• Other good choices include Ortho Tri-Cyclen (norgestimate with ethinyl estradiol) and Diane-35 (cyproterone acetate with ethinyl estradiol), though the latter isn't available in all countries.
• For optimal results, take the pill daily at the same time, and expect to wait 3-6 months to see significant improvement in acne.
• Side effects may include nausea, breast tenderness, and mood changes, which typically improve after a few months.
• These contraceptives are contraindicated in women with certain conditions like history of blood clots, migraines with aura, or liver disease, so a medical evaluation is necessary before starting treatment.

Important Considerations

• The effectiveness of COCs for acne treatment is supported by moderate certainty evidence from multiple studies 1.
• Progestin-only contraceptives and long-acting reversible contraceptives are associated with worsening of acne, and should be avoided in patients with hormonal acne 1.
• A course of three to six months of therapy is typically required for patients to experience the full benefit of treatment with a COC 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 best oral contraceptive for treating hormonal acne is drospirenone and ethinyl estradiol tablets as it is specifically indicated for the treatment of moderate acne vulgaris in women.

• Key considerations: The patient should have no known contraindications to oral contraceptive therapy and have achieved menarche.
• Important note: Drospirenone and ethinyl estradiol tablets should be used for the treatment of acne only if the patient desires an oral contraceptive for birth control 2.

From the Research

Oral Contraceptives for Hormonal Acne

The use of oral contraceptives (OCs) is a common treatment option for hormonal acne in women. Several studies have investigated the efficacy and safety of different OCs in treating acne.

Types of Oral Contraceptives

• Combined oral contraceptives containing ethinyl estradiol and a progestin, such as drospirenone, have been shown to be effective in treating acne 3, 4.
• Drospirenone is a unique progestin with antiandrogenic properties, which can help reduce sebum production and inflammation associated with acne 3.
• Low-dose OCs containing 20 microg of ethinyl estradiol have also been found to be effective in treating acne, with significant reductions in total, inflammatory, and noninflammatory lesions compared to placebo 5.

Efficacy and Safety

• Studies have demonstrated the efficacy and safety of OCs containing drospirenone in treating acne, with no increased risk of vascular thromboembolic disease or arrhythmias observed 3, 4.
• The combination of spironolactone and a combined contraceptive containing drospirenone has also been found to be effective and well-tolerated in treating severe papular and nodulocystic acne in women 6.
• OCs can reduce acne by lowering the production of adrenal and ovarian androgens, inhibiting 5-alpha-reductase, and stimulating sex hormone binding globulin (SHBG), thus reducing the levels of free testosterone 7.

Treatment Options

• OCs can be used as adjunctive therapy to topical agents for women with mild non-scarring acne desiring oral contraception 7.
• OCs can be used as primary therapy for patients with moderate non-scarring acne in combination with topical therapy and systemic antibiotics 7.
• OCs can be used as one of two preferred methods of contraception in patients with scarring and severe inflammatory acne being treated with systemic isotretinoin 7.