Acne: double blind clinical and laboratory trial of tetracycline, oestrogen-cyproterone acetate, and combined treatment.

Abstract

Since the recent introduction of a drug regimen containing 2 mg of the antiandrogen cyproterone acetate and 50 [ig ethinyloestradiol At six months the acne (as assessed by overali grade) had improved by 68% in the antibiotic treated group and by 74% in the oestrogen-cyproterone treated group. The group given a combination of both agents improved by 82%, which was significantly better (p<0025) than the improvement in the tetracycline treated patients. No significant difference was found between the groups given oestrogen-cyproterone alone and the combined treatment. The sebum excretion rate was suppressed by 25% in the patients in both groups receiving oestrogencyproterone but not in the group given antibiotics alone.Oestrogen-cyproterone acetate is as effective as antibiotics in treating acne in women, and adding antibiotics offers no advantage over using oestrogen-cyproterone on its own, although in this study the combination was more effective than tetracycline alone at six months.

Guidelines of care for acne vulgaris management

“…132,133 Cyproterone acetate Cyproterone combined with ethinyl estradiol (in the form of an oral contraceptive) has been found to be effective in the treatment of acne in females. [134][135][136] Higher doses have been found to be more effective than lower doses. Cyproterone/estrogen-containing oral contraceptives are not approved for use in the United States.…”

Hormonelle Antiandrogene in der Aknetherapie

“…Dabei beeinflusste die Konzentration des Ethinylestradiols (35 oder 50 µg) während einer Therapiedauer von 6 bzw. Die 6-monatige Behandlung einer entzündlichen Akne mit Cyproteronacetat 2 mg in Kombination mit Ethinylestradiol (50 µg) war gleich wirksam wie Tetracyclin (1 g) (74 % vs. 68 % globale Besserung der Akne; Evidenzebene 2c -eine Studie, n = 62[49]) bzw. Die 6-monatige Behandlung einer entzündlichen Akne mit Cyproteronacetat 2 mg in Kombination mit Ethinylestradiol (50 µg) war gleich wirksam wie Tetracyclin (1 g) (74 % vs. 68 % globale Besserung der Akne; Evidenzebene 2c -eine Studie, n = 62[49]) bzw.…”

The use of cyproterone acetate/ethinyl estradiol in hyperandrogenic skin symptoms – a review

“…Percentage changes in total lesion count with CPA/EE ranged from 53.6 ± 27.5% (n ¼ 528) to 72 ± 27% (n ¼ 44) [28,30]. Greenwood et al [31] reported an 80% reduction in non-inflammatory and inflammatory lesion counts with CPA/EE (n ¼ 14) at six months. When looking more specifically at types of lesion (comedones, papules, pustules and nodules), statistically significant changes were noted at three months and final numbers of each lesion were reported as 24%, 36%, 17% and 1%, respectively relative to pretreatment (¼100%) at six months in the CPA/EE group (n ¼ 88) by Vartiainen et al [29].…”

“…For example, when combined with antibiotics (tetracycline) in the treatment of acne, or with antiandrogens (finasteride or spironolactone) in the treatment of hirsutism, the potential for enhanced efficacy was suggested [31,36,37,55]. Studies where CPA/EE was added to gonadotropin releasing hormone agonist (GnRHa) to evaluate potential for amplification of treatment response in hyperandrogenic symptoms of PCOS described significant improvement in hirsutism symptoms overall (reductions in hirsutism score were between 24% and 47.4%) but no significant difference between the two groups [50,52,56].…”

“…Changes in lipid levels were also assessed Colver et al [66] 96 Assessment of improvement in acne (visual analogue scale) at nine months in women receiving CPA 2 mg in combination with either 35 lg or 50 lg EE Small (n 100) combination studies (t ! 3 months) Carmina and Lobo [33] 48 Change in Cook scores at 12 months in women receiving CPA 2 mg with 35 lg EE; CPA 50 mg with 25 lg EE (reverse sequential regimen); flutamide 250 mg daily; or finasteride 5 mg daily Greenwood et al [31] 62 Clinical assessment of improvement in acne lesions (severity and number) at six months in women receiving tetracycline alone; oestrogen-CPA; or a combination of these agents. Sebum excretion rates and bacterial counts were also assessed at six months Appendix 3.…”