A Review of hormone-based therapies to treat adult acne vulgaris in women

Abstract

Hormone-based therapies including combined oral contraceptive medications and spironolactone are considered effective therapies to treat adult acne in women. Our objective is to provide a concise and comprehensive overview of the types of hormonal therapy that are available to treat acne and comment on their efficacy and safety profiles for clinical practice. A systematic search using the PubMed Database was conducted to yield 36 relevant studies for inclusion in the review and several conclusions were drawn from the literature.Treatment with oral contraceptive pills leads to significant reductions in lesion counts across all lesion types compared with placebo. There were no consistent differences in efficacy between the different combined oral contraceptive formulations. In terms of risk, oral contraceptive pill users had three-times increased odds of venous thromboembolism versus non-users according to a recent meta-analysis (95% confidence interval 2.46-2.59). Data on oral contraceptive pill use and breast cancer risk are conflicting but individual patient risk factors and histories should be discussed and considered when prescribing these medications. However, use of these medications does confer measurable protection from endometrial and ovarian cancer. Spironolactone was also shown to be an effective alternative treatment with good tolerability.Combined oral contraceptive medications and spironolactone as adjuvant and monotherapies are safe and effective to treat women with adult acne. However, appropriate clinical examinations, screening, and individual risk assessments particularly for venous thromboembolism risk must be conducted prior to initiating therapy.

Correlation of Hormonal Profile and Lipid Levels with Female Adult Acne in a Tertiary Care Center of Nepal

“…Studies report adult acne in up to 60% of patients, with 10% patients between 35 to 44 years of age. 1,3 The mean age of the patients in our study was 28.8±3.64 years, slightly younger than previous reports with mean of 30-35.5 years. 1,[6][7][8][9][10][11][12][13][14][15][16][17][18] Adult acne is persistent or late onset.…”

“…Estrogen decreases sebaceous gland size and sebum production. 3,4 While androgens have clear roles in acne pathogenesis, research continues on the role of estrogen.…”

“…Dyslipidemia is closely linked insulin resistance and hypothyroidism. 3,4,23 PCOS is commonest endocrine disorder in women, with mild elevation of testosterone, hyperinsulinemia, dyslipidemia and elevated LH:FSH ratio. 24 There is low grade chronic inflammation, propagating a vicious cycle of hormonal imbalance and acne in these patients.…”

“…1 With female predominance, it affects 12-22% women between 25 to 50 years age. 2,3 Etiopathogenesis is multifactorial.Hormones implicated are androgens, estrogen, insulin, glucocorticoids, prolactin, etc. Hyperandrogenism(HA) can be ovarian or adrenal in women and Polycystic ovarian syndrome(PCOS) contributes to >90% of such cases.…”

“…[4][5][6][7] Adult acne without hormonal imbalance, suggests end organ hypersensitivity to normal androgen levels. 3,4 Since androgens are derived from plasma cholesterol, lipid alteration might cause acne. 8 In adult acne, evidence for both deranged and normal lipid profile exists.…”