From the Guidelines
For acne treatment, combined oral contraceptive pills (OCPs) containing drospirenone, such as Yaz or Yasmin, are generally considered the best first-line options due to their strong anti-androgenic properties that help reduce sebum production. These medications work by reducing circulating androgens, decreasing sebum production, and reducing inflammation in the skin, as supported by a study published in the Journal of the American Academy of Dermatology in 2024 1. The study highlights that drospirenone is a spironolactone analogue with antiandrogenic properties, making it an effective treatment for acne.
Some key points to consider when using OCPs for acne treatment include:
- They typically require 3-6 months of consistent use before maximum acne improvement is seen
- They should be taken at the same time each day to maintain consistent hormone levels
- Gentle skincare practices, including non-comedogenic moisturizers and sunscreen, should be continued while using OCPs
- Side effects may include nausea, breast tenderness, and mood changes, which often improve after the first few months
- OCPs are contraindicated in women with certain conditions, including history of blood clots, stroke, certain types of migraines, or active liver disease
Other good options for acne treatment include OCPs with norgestimate, such as Ortho Tri-Cyclen, as mentioned in a study published in the Journal of the American Academy of Dermatology in 2019 1. However, drospirenone-containing OCPs are generally favored due to their strong anti-androgenic properties. It's essential to weigh the benefits and risks of OCPs and consider individual patient values and preferences when making treatment decisions, as noted in the 2024 study 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. The Drospirenone and Ethinyl Estradiol tablet is indicated for the treatment of moderate acne vulgaris in women.
- The patient should be at least 14 years of age.
- The patient should have no known contraindications to oral contraceptive therapy.
- The patient should have achieved menarche. This is the only OCP mentioned in the provided drug labels for the treatment of acne, therefore, it can be considered as an option for acne treatment in the specified patient population 2.
From the Research
Oral Contraceptives for Acne Treatment
The use of oral contraceptives (OCs) for acne treatment has been studied extensively. Key findings include:
- OCs are effective in causing a significant regression of mild to moderate acne 3
- The estrogen-progestin combination containing cyproterone acetate (CPA) is particularly effective in treating acne due to its direct peripheral anti-androgenic action 3
- Low-dose OCs are effective in improving acne and have side effects similar to placebo 3, 4, 5
Comparison of Different Oral Contraceptives
Studies have compared the efficacy of different OCs in treating acne:
- A combined OC containing drospirenone (DRSP) was found to be superior to a triphasic preparation containing norgestimate in acne treatment 6
- DRSP-containing OCs have been shown to be effective in placebo-controlled superiority trials and in active-comparator non-inferiority trials 7
- The use of low-dose OCs, such as those containing 20 microg of ethinyl estradiol, has been supported by clinical trials 5
Mechanism of Action
The mechanism of action of OCs in treating acne involves:
- Decrease in ovarian and adrenal androgen precursors 3
- Increase in sex hormone-binding globulin (SHBG), which limits free testosterone 3, 6
- Decrease in 3a-androstenediol glucuronide conjugate, the catabolite of dihydrotestosterone (DHT) formed in peripheral tissues 3
- Antiandrogenic properties of certain progestins, such as drospirenone 7, 6