Acne is a multifactorial disease, also known as Pimples or Zits. It is a common disorder affecting teenagers and, at times, young adults. It is caused by abnormal keratinization, increased sebum production, bacterial infection and local inflammation of the skin, due to the blockage of skin pores. Usually acne appears on the face but can extend to neck, chest and back also.
Acne has a profound economic as well as psychosocial impact on those who suffer from its symptoms. Physicians have known for many years that oral contraceptives (OCs) can reduce the incidence of acne and help diminish acne lesions. The mechanism by which OCs improve acne most likely involves a decrease in the amount of circulating androgens. Specifically, OCs reduce total and bio-available testosterone and increase the production of sex hormone binding globulin. In addition, the steroids in OCs suppress pituitary gonadotropin secretion, thereby decreasing the levels of ovarian androgens.
An article, to be published in Contraception (available online 26 September, 2005), reviews data from clinical trials of various designs that demonstrate the efficacy of OCs in treating acne, with a focus on the trend toward treating acne with OCs containing low doses of hormones as shown in placebo-controlled trials.
The authors Johannes Huber and Katharina Walch have included clinical trials of various doses of ethinyl estradiol (EE) combined with progestins such as levonorgestrel, desogestrel, norgestimate, gestodene, cyproterone acetate and drospirenone in monophasic, triphasic and combiphasic formulations used to treat acne in women. Open-label and comparative studies beginning in the 1980s were the first to demonstrate objective and subjective reductions in the incidence of acne, severity of existing acne and seborrhea. Placebo-controlled trials have corroborated these findings with a trend toward effective acne treatment with declining doses of EE. Significant reductions in total, inflammatory and noninflammatory lesions compared with placebo have been demonstrated with an OC containing low dose of EE.
The authors, from the Department of Obstetrics and Gynecology, Medical University Vienna, Austria, summarize that these findings support the use of low-dose OCs for the treatment of acne, and the effectiveness of a low-dose OC in the treatment of acne should facilitate the initiation of OCs with the lowest effective hormonal dose.