From the Guidelines
Cyproterone acetate can be effective for treating acne, particularly in women with hormonal acne, as part of a combined oral contraceptive pill, with a standard regimen involving taking one pill daily for 21 days followed by a 7-day break, then repeating the cycle, as supported by studies such as 1 and 1.
Key Points to Consider
- Cyproterone acetate is typically prescribed as part of a combined oral contraceptive pill (such as Diane-35 or Estelle-35) containing 2mg of cyproterone acetate and 35mcg of ethinylestradiol.
- The standard regimen involves taking one pill daily for 21 days followed by a 7-day break, then repeating the cycle.
- Treatment usually requires 3-6 months to show significant improvement, and may be continued for 12-24 months depending on response.
- For severe cases in women, higher doses of cyproterone acetate (25-50mg daily) may be prescribed alongside estrogen.
- Cyproterone acetate works by blocking androgen receptors and reducing sebum production, which helps prevent acne formation, as noted in studies such as 1 and 1.
- It also suppresses testosterone production.
- Side effects may include breast tenderness, nausea, headaches, and mood changes.
- It's essential to note that cyproterone acetate is not approved for acne treatment in men due to feminizing effects and is contraindicated in pregnancy.
- Regular follow-up appointments are necessary to monitor for potential adverse effects, including rare but serious risks like venous thromboembolism, as highlighted in studies such as 1 and 1.
Important Considerations
- The use of cyproterone acetate for acne treatment should be based on the most recent and highest quality evidence, such as the guidelines of care for the management of acne vulgaris published in the Journal of the American Academy of Dermatology 1.
- The benefits and risks of cyproterone acetate should be carefully weighed, considering the individual patient's needs and medical history.
- Patients should be educated about the potential side effects and risks associated with cyproterone acetate, as well as the importance of regular follow-up appointments to monitor their condition.
From the Research
Efficacy of Cyproterone Acetate for Acne
- Cyproterone acetate has been shown to be effective in treating acne, particularly in women with androgen-related acne 2, 3, 4, 5.
- A study published in 1999 found that a combination of cyproterone acetate and ethinylestradiol resulted in a "good" or "very good" therapeutic response in 82.8% of patients with facial acne 2.
- Another study published in 2017 reviewed the data on the efficacy and safety of cyproterone acetate combined with ethinylestradiol for the treatment of hyperandrogenic skin symptoms, including acne, and found that the majority of studies showed a high efficacy of this treatment 3.
- Topical cyproterone acetate alcohol lotion has also been shown to be effective in treating mild to moderate acne vulgaris, with a reduction in total acne lesions counting of up to 90% 6.
Mechanism of Action
- Cyproterone acetate is a potent antiandrogen with strong progestational activity, which helps to reduce sebum excretion and alleviate acne symptoms 2, 4.
- The combination of cyproterone acetate and ethinylestradiol provides effective contraceptive protection and helps to regulate hormonal imbalances that can contribute to acne 2, 3.
Safety and Tolerability
- Cyproterone acetate has been shown to be well tolerated, with only 3.4% of patients discontinuing treatment due to adverse events in one study 2.
- The majority of adverse events were described as mild, and their incidence declined as the study progressed 2.
- A review of the safety and tolerability data for cyproterone acetate combined with ethinylestradiol found that the treatment was generally well tolerated, with some benefits including cycle control and improvement in mood and perception of body image 3.