A Review of Hormone-Based Therapies in the Treatment of Adult Acne: Safety and Efficacy [2A]

INTRODUCTION: Hormone-based therapies which include combined oral contraceptives and spironolactone have been considered effective alternatives to conventional therapies for adult onset acne which has a high rate of treatment failure. Our objective is to provide a concise and comprehensive overview of the types of hormone therapy available for acne treatment and comment on their efficacy and safety profiles for clinical practice. METHODS: A systematic search using the PubMed Database was conducted with the following search terms “contraceptives,” “hormone therapy,” “spirinolactone,” “flutamide,” and “acne treatment.” “Polycystic ovarian syndrome,” “endometriosis,” and “hidradenitis supparativa” were excluded. Filters included human studies published after Jan 1, 2000. 236 results were then manually filtered using a systematic approach to yield 39 relevant studies. RESULTS: It was found that OCP’s led to significant reductions in lesion counts across all lesion types compared to placebo. No consistent differences in efficacy between different combined OCPs were found. In terms of risk, OCP users had a three times increased odds of VTE versus non-users in a recent meta-analysis (95% CI 2.46-2.59). OCP’s conferred slightly higher risk of breast cancer but reduced risk of endometrial and ovarian cancer. Spironolactone was also shown to be an effective alternative with few side effects. CONCLUSION: Combined oral contraceptives and spironolactone as adjuvant and monotherapies are safe and effective in patients with adult-onset acne that is refractory to conventional treatments. However, appropriate clinical exam, screening, and individual risk assessment especially for VTE risk must be conducted in order to maximize benefits of therapy for each patient.