What birth control methods are recommended for acne treatment?

From the Guidelines

Combined oral contraceptives (COCs) are recommended for treating acne in women, particularly those with anti-androgenic progestins like drospirenone, norgestimate, or desogestrel, as they have been shown to reduce acne severity and improve quality of life 1. The most effective options include pills containing both estrogen and progestin, which work by reducing sebum production, decreasing inflammation, and lowering levels of androgens (male hormones) that contribute to acne formation. Some key points to consider when prescribing COCs for acne treatment include:

• Specific FDA-approved brands for acne treatment include norgestimate/EE, norethindrone acetate/EE/ferrous fumarate, drospirenone/EE, and drospirenone/EE/levomefolate 1.
• COCs may be used alone or in combination with other acne treatments, and their use should be considered in women who desire contraception or have signs of hyperandrogenism 1.
• The use of COCs for acne treatment has been shown to be effective in reducing acne severity, with a greater proportion of patients achieving success compared to placebo 1.
• Side effects of COCs may include nausea, breast tenderness, headaches, and spotting, but these typically subside after a few months 1.
• It's essential to consult a healthcare provider before starting any hormonal treatment for acne to determine the most appropriate option based on individual health history and needs, as COCs may not be suitable for everyone, particularly those with certain risk factors like history of blood clots, stroke, or certain cancers 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.

Drospirenone and ethinyl estradiol tablets are a combination of drospirenone, a progestin, and ethinyl estradiol, an estrogen, indicated for use by females of reproductive potential to: • Treat moderate acne for women at least 14 years old only if the patient desires an oral contraceptive for birth control. (1.3)

Birth control recommended for acne:

• Drospirenone and ethinyl estradiol tablets are indicated for the treatment of moderate acne vulgaris in women at least 14 years of age.
• The tablets should be used for the treatment of acne only if the patient desires an oral contraceptive for birth control.
• Key points to consider:
  • The patient must have no known contraindications to oral contraceptive therapy.
  • The patient must have achieved menarche.
  • The tablets are intended for use in females of reproductive potential.
  • The treatment of acne is an off-label use of the tablets if the patient does not desire birth control 2, 2.

From the Research

Birth Control for Acne Treatment

• Birth control pills have been shown to be effective in treating acne, particularly those containing ethinyl estradiol (EE) and progestins such as levonorgestrel, desogestrel, norgestimate, gestodene, cyproterone acetate, and drospirenone 3.
• Low-dose oral contraceptives (OCs) have been found to be effective in reducing total, inflammatory, and noninflammatory lesions compared to placebo 3.
• A triphasic combined oral contraceptive containing EE and norgestimate has been approved by the Food and Drug Administration and the European Medicine Agency for the treatment of acne vulgaris in women requiring effective contraception 4.
• The use of a combined contraceptive containing drospirenone has been shown to be superior to a triphasic preparation containing norgestimate in acne treatment, with significant reductions in total lesion count and investigators' assessment of therapeutic effect 5.

Mechanism of Action

• Combined oral contraceptives can target sebum production and decrease follicular hyperkeratinisation, making them an effective treatment option for acne 4.
• Drospirenone, a unique progestin, has antiandrogenic and antimineralocorticoid properties, which contribute to its efficacy in acne treatment 5, 6.
• The combination of EE and drospirenone has been shown to increase sex hormone-binding globulin (SHBG) levels and decrease androgen levels, changes typically associated with acne improvement 5, 6.

Safety and Efficacy

• The combination of spironolactone and a combined contraceptive containing drospirenone has been found to be safe and effective in the treatment of severe papular and nodulocystic acne in women 7.
• Drospirenone-containing OCs have been shown to be well-tolerated and effective in the treatment of acne, with no increased risk of vascular thromboembolic disease or arrhythmias observed in large epidemiological studies 6.