Overview of New Therapeutic Developments for Acne

Anja Thielitz; Harald Gollnick

Disclosures

April 13, 2009

In This Article

Hormonal Therapy

Androgens, such as dihydrotestosterone and testosterone, the adrenal precursor dehydroepiandrosterone sulfate, estrogens, growth hormone and insulin-like growth factors contribute to the development of acne. Hormonal therapy is a useful alternative regimen in female acne and is mandatory in late-type acne and in patients with signs of hyperandrogenism, such as hirsutism, seborrhoea or androgenetic alopecia.[65]

The mainstays of hormonal therapy include oral contraceptives and anti-androgens, such as spironolactone, cyproterone acetate or flutamide. The efficacy of oral contraceptives and other anti-androgens in acne treatment has been comprehensively reviewed, which revealed that ethinylestradiol/drospirenone and ethinylestradiol/cyproterone are most effective followed by ethinylestradiol/desogestrel and ethinylestradiol/gestodene.[66,67] Ethinylestradiol/chlormadinone is slightly better than ethinylestradiol/levonorgestrel, which is as effective as ethinylestradiol/norethindrone, which is far better than placebo. The effect of drospirenone, a relatively new progestin available in certain oral contraceptives, was investigated recently in two large, randomized, placebo-controlled clinical studies involving 534 and 538 women with moderate acne.[68,69] Both studies showed that treatment with the drospirenone 3-mg/ethinyl estradiol 20-µg combination administered as 24 consecutive days of active treatment after a 4-day hormone-free interval for six cycles was associated with a greater reduction from baseline to end point in individual acne lesion counts and investigators' assessment compared with placebo. There is further evidence from one comparative clinical trial incorporating 128 patients that drospirenone 3 mg/ethinyl estradiole 30 µg and cyproterone acetate 2 mg/ethinyl estradiole 35 µg are equally effective in acne treatment.[70] Combined with ethinyl estradiol in oral contraceptive formulations, drospirenone-containing contraceptives have similar efficacy and safety profiles to other low-dose oral contraceptives but seem to offer improved tolerability with regard to weight gain, mood changes, acne and premenstrual dysphoric disorder.[71] Beside classical indications for hormonal acne therapy, women with moderate acne who seek contraception and teenagers with acne who refuse antibiotics or in whom topical antibiotics are ineffective might be candidates for drospirenone-containing oral contraceptives.

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