From the Guidelines
Drospirenone-containing combined oral contraceptives like Yaz, Yasmin, and their generics are generally considered the best COCs for acne treatment. These pills contain ethinyl estradiol (typically 20-35 mcg) combined with 3 mg of drospirenone, which has anti-androgenic properties that help reduce sebum production and improve acne 1. The standard regimen involves taking one pill daily for 21 days followed by 7 days of placebo pills (or 24 active pills and 4 placebo pills in some formulations), then repeating the cycle. Other effective options include pills containing norgestimate (like Ortho Tri-Cyclen) or cyproterone acetate (not available in the US). Improvement typically begins after 2-3 months of use, with maximum benefits seen at 6 months. These contraceptives work by reducing androgen levels, decreasing sebum production, and reducing inflammation in the skin.
Some key points to consider when prescribing COCs for acne treatment include:
- The patient's medical history, including any history of blood clots, stroke, or certain types of migraines 1
- The patient's smoking status, as smokers over 35 years old are at increased risk of cardiovascular events 1
- The potential for drug interactions, such as with anticonvulsants or antiretroviral drugs 1
- The importance of counseling patients on proper use and potential side effects, such as irregular bleeding or nausea 1
It's also important to note that COCs are contraindicated in women with certain conditions, so a medical evaluation is necessary before starting treatment 1. Overall, drospirenone-containing COCs are a effective and safe option for acne treatment in women who desire oral contraception, as long as they are used under the guidance of a healthcare provider and with careful consideration of the patient's individual needs and medical history.
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.
The best COCP for acne treatment is drospirenone and ethinyl estradiol tablets.
- Key points:
- Indicated for moderate acne vulgaris
- For women at least 14 years of age
- No known contraindications to oral contraceptive therapy
- Must have achieved menarche
- This COCP should be used for the treatment of acne only if the patient desires an oral contraceptive for birth control 2.
From the Research
Best COCP for Acne Treatment
The best combined oral contraceptive pill (COC) for acne treatment is a matter of ongoing research and debate. Several studies have investigated the efficacy of different COCs in reducing acne lesions and improving skin condition.
- Key Findings:
- A study published in 2000 3 found that all low-dose combination OCs are equally beneficial in women with androgenic conditions such as acne, as they are estrogen dominant.
- A 2012 review of 31 trials 4 concluded that COCs are effective in reducing inflammatory and non-inflammatory facial acne lesions, but found few important and consistent differences between COC types.
- A 2009 study 5 found that a COC containing dienogest was superior to placebo and non-inferior to a COC containing cyproterone acetate in improving mild to moderate acne.
- Another study from 2004 6 found that a COC containing drospirenone was superior to a triphasic preparation containing norgestimate in acne treatment.
- A 2009 trial 7 found that a low-dose COC containing 3 mg drospirenone plus 20 microg ethinylestradiol significantly reduced acne lesions compared to placebo.
Comparison of COCs
- Drospirenone: Studies have shown that COCs containing drospirenone, such as Yasmin, are effective in reducing acne lesions and improving skin condition 6, 7.
- Dienogest: A COC containing dienogest has been found to be superior to placebo and non-inferior to a COC containing cyproterone acetate in improving mild to moderate acne 5.
- Cyproterone acetate: COCs containing cyproterone acetate have been found to be effective in improving acne, but may have varying degrees of efficacy compared to other COCs 4, 5.
- Norgestimate: A triphasic preparation containing norgestimate has been found to be less effective than a COC containing drospirenone in acne treatment 6.