Ethinylestradiol/Chlormadinone Acetate

Abstract

Acne vulgaris, hirsutism, seborrhea and female pattern hair loss (FPHL) are common disorders of the pilosebaceous unit (PSU). In some women with hyperandrogenemia, an excess of androgens at the PSU can lead to the development of these dermatological manifestations. These manifestations can cause many psychiatric and psychological implications, such as social fears and anxiety, and can adversely affect quality of life. High androgen levels at the PSU as a possible underlying cause of acne vulgaris, hirsutism, seborrhea and FPHL supports the rationale for using combined oral contraceptives for the management of these conditions in women. The purpose of this review is to describe these dermatological manifestations of the PSU and the management of these conditions through the use of the oral contraceptive ethinylestradiol/chlormadinone acetate (EE/CMA). EE/CMA 0.03/2 mg is a combined monophasic contraceptive pill with anti-androgenic properties. It is approved in Europe for contraception and has been investigated in phase III trials for the treatment of acne. EE/CMA was better than placebo and similar to another low-dose oral contraceptive (ethinylestradiol/levonorgestrel) in improving symptoms of acne in two phase III randomized controlled trials in patients with mild to moderate papulopustular acne. In addition, in trials investigating the contraceptive efficacy of EE/CMA, limited data suggest that there were also improvements in hirsutism, FPHL and seborrhea in small subgroups of patients. EE/CMA has a good safety profile. The most commonly reported adverse events are breast tenderness/pain, headache/migraine and nausea. Evidence in the literature indicates that the use of EE/CMA for the treatment of dermatological disorders under the control of androgens may be a valid treatment option. Further investigation is warranted.

Use of oral contraceptives for management of acne vulgaris and hirsutism in women of reproductive and late reproductive age

“…Chlormadinone acetate (2 mg of chlormadinone acetate and 0.03 mg of ethinyl oestradiol) was effective in the treatment of mild to moderate acne and hirsutism [ 20 ], caused visible improvement in hirsutism and seborrhoea after 12 months of treatment [ 21 ], improvement of acne after 3, 6, and 12 months of treatment [ 22 ], and a relevant decrease of percentage of patients suffering from acne from 46.5% to 14.9% after 13 cycles of treatment [ 23 ]. Chlormadinone acetate reduced the number of patients with skin problems (–55%), reduced the number of patients seeking dermatological treatment (–67%) and concealer cosmetics (–55%) and the number of patients who felt that their self-esteem was restricted due to skin problems (–67%) [ 24 ].…”

El ovario poliquístico y las enfermedades dermatológicas

“…Si estas no resultan efectivas, podemos iniciar un tratamiento con un ACO con perfil antiandrogénico como aquellos que contienen acetato de ciproterona o drospirenona [29][30][31] . Si a los 3-6 meses de iniciado el tratamiento no resulta suficientemente efectivo, se puede añadir espironolactona, con las mismas consideraciones que las expuestas anteriormente.…”

What′s new in the management of acne?

“…Only few head to head comparative trials have been done comparing combined oral contraceptives (COC's) with other acne treatments. [55] COC's work well in acne with estrogen suppressing sebaceous gland activity and decreasing the formation of ovarian and adrenal androgens. Progestogen-only contraceptives tend to flare acne and should be avoided in women who have no contraindications to oestrogen-containing preparations.…”