Research Article| Volume 35, ISSUE 2, P168-172, March 2017

Hormonal therapies for acne


      Acne is a common, worldwide problem that is usually multifactorial in etiology, but androgens may play a pivotal role in the development and severity of acne. Endocrinopathies, such as polycystic ovarian syndrome, ovarian tumors, or adrenal hyperplasia or tumors, may be detected in some patients with acne, especially if acne is sudden in onset, associated with hirsutism or menstrual irregularities, or associated with cushingoid facies, acanthosis nigricans, patterned hair loss, or deepened voice. In these instances, serum-free and total testosterone, dehydroepiandrosterone, luteinizing hormone, and follicle stimulating hormone should be tested. Appropriate referral and long-term follow-up is warranted in patients diagnosed with an endocrinopathy. Hormonal therapies for acne include systemic medications with various mechanisms: androgen receptor blockers, adrenal androgen production blockers, or ovarian androgen production blockers. Androgen receptor blockers include spironolactone, cyproterone acetate, chlormadinone, and flutamide; adrenal androgen production blockers include glucocorticoids; and ovarian production blockers include gonadotropin-releasing agonists and oral contraceptives. Practical guidelines are shared for the practicing physician treating hormonally related acne.
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        • Tan J.K.
        • Bhate K.
        A global perspective on the epidemiology of acne.
        Br J Dermatol. 2015; 172: 3-12
        • Cappel M.
        • Mauger D.
        • Thiboutot D.
        Correlation between serum levels of insulin-like growth factor 1, dehydroepiandrosterone sulfate, and dihydrotestosterone and acne lesion counts in adult women.
        Arch Dermatol. 2005; 141: 333-338
        • Nagpal M.
        • De D.
        • Handa S.
        • et al.
        Insulin resistance and metabolic syndrome in young men with acne.
        JAMA Dermatol. 2016; 152: 399-404
        • Schmidt T.H.
        • Khanijow K.
        • Cedars M.I.
        • et al.
        Cutaneous findings and systemic associations in women with polycystic ovary syndrome.
        JAMA Dermatol. 2016; 152: 391-398
        • Thiboutot D.
        Acne: hormonal concepts and therapy.
        Clin Derm. 2004; 22: 419-428
        • Thiboutot D.M.
        Endocrinological evaluation and hormonal therapy for women with difficult acne.
        J Eur Acad Dermatol Venereol. 2001; 15: S57-S61
        • Goodfellow A.
        • Alaghband-Zadeh J.
        • Carter G.
        • et al.
        Oral spironolactone improves acne vulgaris and reduces sebum excretion.
        Br J Dermatol. 1984; 111: 209-214
        • Yemisci A.
        • Gorgulu A.
        • Piskin S.
        Effects and side-effects of spironolactone therapy in women with acne.
        J Eur Acad Dermatol Venereol. 2005; 19: 163-166
        • Hecker A.
        • Hasan S.H.
        • Neumann F.
        Disturbances in sexual differentiation of rat foetuses following spironolactone treatment.
        Acta Endocrinol (Copenh). 1980; 95: 540-545
        • Plovanich M.
        • Weng Q.Y.
        • Mostaghimi A.
        Low usefulness of potassium monitoring among healthy young women taking spironolactone for acne.
        JAMA Dermatol. 2015; 151: 941-944
        • Biggar R.J.
        • Andersen E.W.
        • Wohlfahrt J.
        • et al.
        Spironolactone use and the risk of breast and gynecologic cancers.
        Cancer Epidemiol. 2013; 37: 870-875
        • van Wayjen R.G.
        • van den Ende A.
        Experience in the long-term treatment of patients with hirsutism and/or acne with cyproterone acetate-containing preparations: efficacy, metabolic, and endocrine effects.
        Exp Clin Endocrinol Diabetes. 1995; 103: 241-251
        • Seaman H.E.
        • de Vries C.S.
        • Farmer R.D.
        The risk of liver disorders in women prescribed cyproterone acetate in combination with ethinyloestradiol (Dianette): a nested case-control study using the GPRD.
        Pharmacoepidemiol Drug Saf. 2003; 12: 541-550
        • Worret I.
        • Arp W.
        • Zahradnik H.P.
        • et al.
        Acne resolution rates: results of a single-blind, randomized, controlled, parallel phase III trial with EE/CMA (Belara) and EE/LNG (Microgynon).
        Dermatology. 2001; 203: 38-44
        • Guerra-Tapia A.
        • Sancho P.B.
        Ethinylestradiol/Chlormadinone acetate: dermatological benefits.
        Am J Clin Dermatol. 2011; 12: S3-S11
        • Cusan L.
        • Dupont A.
        • Bélanger A.
        • et al.
        Treatment of hirsutism with the pure antiandrogen flutamide.
        J Am Acad Dermatol. 1990; 23: 462-469
        • Katsambas A.D.
        • Dessinioti C.
        Hormonal therapy for acne: why not as first line therapy? Facts and controversies.
        Clin Dermatol. 2010; 28: 17-23
        • Faloia E.
        • Filipponi S.
        • Mancini V.
        • et al.
        Treatment with a gonadotropin-releasing hormone agonist in acne or idiopathic hirsutism.
        J Endocrinol Invest. 1993; 16: 675-677
        • Koltun W.
        • Lucky A.W.
        • Thiboutot D.
        • et al.
        Efficacy and safety of 3 mg drospirenone/20 mcg ethinylestradiol oral contraceptive administered in 24/4 regimen in the treatment of acne vulgaris: a randomized, double-blind, placebo-controlled trial.
        Contraception. 2008; 77: 249-256
        • Gallo M.F.
        • Lopez L.M.
        • Grimes D.A.
        • et al.
        Combination contraceptives: effects on weight.
        Cochrane Database Syst Rev. 2014; 29CD003987
        • Sonalkar S.
        • Schreiber C.A.
        • Barnhart K.T.
        Contraception. 2014 Nov 11.
        in: De Groot L.J. Beck-Peccoz P. Chrousos G. Endotext [Internet]., Inc., South Dartmouth (MA)2000
        • Horton L.G.
        • Simmons K.B.
        • Curtis K.M.
        Combined hormonal contraceptive use among obese women and risk for cardiovascular events: A systematic review.
        Contraception. 2016; 1: 1-15
        • ACOG Committee on Practice Bulletins-Gynecology
        ACOG practice bulletin. No. 73: Use of hormonal contraception in women with coexisting medical conditions.
        Obstet Gynecol. 2006; 107: 1453-1472