From the Guidelines
Pulse cyproterone acetate is not recommended as a first-line treatment for acne due to its potential risks and side effects, and instead, combined oral contraceptive pills (COCs) containing antiandrogenic progestins such as drospirenone should be considered for women with acne who also desire contraception. The use of cyproterone acetate for acne treatment is not well-supported by recent evidence, and its risks, including venous thromboembolic events (VTEs) and feminizing side effects, must be carefully weighed against its potential benefits 1.
Mechanism of Action and Efficacy
COCs, on the other hand, have been shown to be effective in reducing acne lesions through their antiandrogenic properties, which decrease androgen production and increase sex hormone-binding globulin, binding free circulating testosterone and rendering it unavailable to bind and activate the androgen receptor 1. A 2012 Cochrane metaanalysis assessed the effect of birth control pills on acne in women and included 31 trials with a total of 12,579 women, finding that COCs reduce acne—both inflammatory and comedonal lesion counts 1.
Risks and Considerations
While COCs are associated with cardiovascular risks, including VTEs and myocardial infarction, the absolute risk remains low in healthy, normotensive, nondiabetic, nonsmokers at any age 1. The risks of COCs must be weighed against the risks of the condition that they are treating or preventing, and women should be carefully selected and monitored for potential side effects.
Treatment Recommendations
For women with acne who also desire contraception, COCs containing antiandrogenic progestins such as drospirenone may be a suitable treatment option, with the added benefit of providing effective contraception. Treatment duration and dosage should be individualized based on the severity of acne and the woman's medical history, with regular monitoring for potential side effects and adjustments made as necessary. The use of pulse cyproterone acetate for acne treatment should be reserved for severe cases where other treatments have failed, and under close supervision due to its potential risks and side effects.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Pulse Cyproterone Acetate for Acne
- Pulse cyproterone acetate is used in the treatment of acne, particularly in women with hyperandrogenism and menstrual abnormalities 2.
- The combination of cyproterone acetate and ethinyl estradiol has been shown to be effective in reducing acne symptoms, with studies demonstrating significant improvements in patients with moderate to severe acne 3, 4.
- The efficacy of cyproterone acetate in treating acne is thought to be due to its anti-androgenic properties, which help to reduce sebum production and prevent the formation of comedones and inflammatory lesions 2.
- Low-dose oral contraceptives, including those containing cyproterone acetate, have been shown to be effective in treating acne, with declining doses of ethinyl estradiol also demonstrating efficacy 5.
- Studies have reported varying response rates to cyproterone acetate treatment, with some patients showing a very good response, while others experience moderate or no improvement 3, 4.
- The safety of cyproterone acetate has been evaluated, with some studies suggesting that the risks of venous thromboembolism are no more common than with the use of third-generation combined oral contraceptives 2.