Discuss the use of OCs in the treatment of acne.

OCs most often used today to treat acne are a combination of ethinyl estradiol and a progestin. The only OCs officially approved by the Food and Drug Administration (FDA) for use in acne are Ortho-TriCyclen (Ortho-McNeil Pharmaceutical, Raritan, NJ), Estrostep (Parke-Davis, Detroit, MI), and, most recently, YAZ (Bayer Healthcare Pharmaceuticals, Montville, NJ). The second- and the third-generation progestins combined with an estrogen are the most appropriate choices for the treatment of acne because they have the lowest androgenic activity (Table 21-1). Multiple studies suggest that OCs are significantly better than placebo in the treatment of mild to moderate acne. The trials comparing different OCs are somewhat conflicting. OCs work by suppressing the endogenous production of androgens, reducing free testosterone, and increasing sex hormone–binding globulin. Patients should be screened for risk factors associated with OCs prior to beginning this therapy (see Table 21-1). The World Health Organization and the American College of Obstetricians and Gynecologists no longer require pelvic exam before initiating OC therapy in most healthy female patients of childbearing age.

Arowojulo AO, Gallo MF, Lopez LM, et al: Combined oral contraceptive pills for treatment of acne, Cochrane Database Syst Rev 8;(3): CD004425, 2009.

Frangos JE, Alvaian CN, Kimball AB: Acne and oral contraceptives: update on women’s health screening guidelines, J Am Acad Dermatol 58:781–786, 2008.

Sawaya ME: Antiandrogens and androgen inhibitors, In Wolverton SE, editor: Comprehensive dermatologic drug therapy, ed 2, Philadelphia, 2007, Saunders, pp 430–432.

Table 21-1. Combination Oral Contraceptives for Acne
	ESTROGEN		PROGESTIN		BRAND NAMES		OTHER INFORMATION
	Ethinyl estradiol		Desogestrel		Apri, Cyclessa, Desogen, Ortho-Cept		3rd-generation progestin
	Ethinyl estradiol		Gestodene		N/A (not available in U.S.)		3rd-generation progestin
	Ethinyl estradiol		Norgestimate		Mononessa, Ortho Cyclen, Orthotricylcen, Orthotricyclen Lo, Sprintec, Trinessa		3rd-generation progestin
	Ethinyl estradiol		Norethindrone		Brevicon, Estrostep, Junel, Modicon, Necon, Nelova, Norethin, OrthoNovum, Ovcon-35, TriNorinyl		2nd-generation progestin
	Ethinyl estradiol		Ethynodiol diacetate		Demulen, Ovulen, Zovia		2nd-generation progestin
	Ethinyl estradiol		Levonorgestrel		Alesse, Aviane, Empresse, Levlen, Levlite, Lovora, Nordette, Portia, TriLevlen, Triphasil, Trivora		2nd-generation progestin
	Ethinyl estradiol		Drospirenone		Yasmin, YAZ		New progestin that is an analog of spironolactone Has antiandrogenic and antimineralocorticoid properties