Hormonal therapy for women with acne vulgaris
- Emmy Graber, MD, MBA
Emmy Graber, MD, MBA
- Clinical Instructor
- Northeastern University
- Section Editors
- Robert P Dellavalle, MD, PhD, MSPH
Robert P Dellavalle, MD, PhD, MSPH
- Section Editor — Dermatology
- Professor of Dermatology and Public Health
- Denver VA Medical Center, University of Colorado School of Medicine and Colorado School of Public Health
- Mark V Dahl, MD
Mark V Dahl, MD
- Section Editor — Acne and Rosacea
- Professor Emeritus
- Mayo Clinic College of Medicine
Androgens play an important role in the pathogenesis of acne vulgaris. Thus, hormonal interventions that reduce androgen activity can be effective treatments. Post-menarchal women with moderate to severe acne are the primary candidates for hormonal therapy. Oral contraceptives and spironolactone are commonly prescribed hormonal therapies.
Hormonal therapy for women with acne vulgaris is discussed here. Nonhormonal acne therapy is reviewed separately. (See "Treatment of acne vulgaris" and "Oral isotretinoin therapy for acne vulgaris" and "Light-based, adjunctive, and other therapies for acne vulgaris".)
HORMONES IN ACNE
Androgens and estrogens significantly impact the pathogenesis of acne. Therefore, understanding the role of these hormones is important for grasping the rationale for hormonal therapy. In general, androgens have stimulatory effects on acne, whereas estrogens have inhibitory effects on acne.
Androgens — Androgens contribute to acne through the promotion of sebum production by sebaceous glands in the skin . The increase in sebum production contributes to the accumulation of sebum and keratinous material in pilosebaceous follicles. This leads to partial obstruction of the follicle, resulting in the formation of comedones, the primary lesions of acne (picture 1A-B). (See "Pathogenesis, clinical manifestations, and diagnosis of acne vulgaris", section on 'Pathogenesis'.)
Sebum also provides a growth medium for Propionibacterium acnes, a bacterium that resides in pilosebaceous follicles and contributes to the inflammatory response in acne vulgaris (picture 2) . The correlation between the normal rise in serum androgen levels and sebum production in the prepubertal period and the typical age of onset of acne (also the prepubertal period) supports an important role for androgens in acne. This importance of androgens is also supported by the occurrence of acne as a clinical feature of hyperandrogenism. (See "Adrenal hyperandrogenism", section on 'Clinical manifestations' and "Clinical manifestations of polycystic ovary syndrome in adults", section on 'Hyperandrogenism'.)
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- HORMONES IN ACNE
- OVERVIEW OF HORMONAL THERAPY
- Approach to therapy
- Oral contraceptives
- - Efficacy
- Combination oral contraceptives with antiandrogenic progestins
- Comparison to oral antibiotic therapy
- - Selection of an oral contraceptive
- - Progestin-only contraceptives
- - Side effects
- - Antibiotics and contraceptive efficacy
- - Efficacy and administration
- - Side effects
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS