The best OCP Tx for acne
LINDA WYSE, MD, of Montreal, QC, wonders, "What's the best birth control pill (OCP) for the treatment of acne? Are doctors still prescribing cyproterone/ ethinyl estradiol, despite a four-fold increase in blood clots?"
Your question has two parts, which I will answer separately. Acne vulgaris, androgenetic hair loss, hirsutism and even hidradenitis suppurativa are influenced by endogenous androgens. Some women are genetically more responsive to these, and as the ovaries account for most of the androgen production, suppression by oral contraceptive agents can be beneficial in treating these skin conditions. Most oral formulations are a combination of estrogens and progestins. Some progestins are more readily converted into a dihydrotestosterone-like metabolite and can aggravate acne. OCPs containing levonorgestrel, norgestrel, norethindrone acetate and norethindrone have significant androgen activity. Desogestrel and norgestimate, however, have low androgen activity and may improve acne. Because cyproterone is a progestin with strong anti-androgenic activity, it's a very effective agent for controlling hyperandrogenic conditions. The risk for thromboembolism with combination OCPs is well-established, due to the estrogenic component present in all of them. The type of progestin used doesn't seem to affect the risk. Because probability increases with smoking and genetic predisposition to hypercoagulable states, all individuals being considered for an estrogen-containing medication should be asked about previous clotting events, migraines, breast cancer risk in the family and smoking history. With proper patient selection and counselling, these agents can be very effective in managing acne. GS (see our ob/gyn response to this question in the obstetrics gynecology category)