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Attendees learning the latest in the field.
WHICH ORAL CONTRACEPTIVE
WORKS IN ACNE?
It is likely that many oral contraceptives have some impact in
acne. The dermatologist should choose one or two pills with
which he or she feels comfortable and use those. The U.S.
Food and Drug Administration (FDA) approved 3 oral contraceptives
to treat acne: Estrostep, Ortho Tri-Cyclen and YA Z ,
which is the newcomer. YAZ was FDA approved for acne in
2007. A Cochrane meta-analysis evaluated 21 studies using
oral contraceptive pills in the management of acne. The number
one conclusion is it is difficult to compare trials because
investigators in acne studies do not always use the same stand
a rd to measure whether or not acne is improving. The only
real conclusion the authors could draw was that combination
oral contraceptive pills that contained either cypro t e ro n e
acetate or chlormadinone acetate — both of which are not
available in the United States — were more effective than oral
contraceptive pills that contained levonorgestrel.
One study compared the effect of Yasmin to Diane-35 on
cases of mild to moderate acne. Yasmin has dro s p i renone (3
mg), while Diane-35 has cypro t e rone acetate (2 mg), which
also is antiandrogenic. In the head-to-head comparison, 128
people were included for 9 cycles of treatment. In both
g roups, the lesion counts were reduced by about 60% and the
sex hormone binding globulin increased 3-fold in both groups.
Yasmin also was compared head to head with Ortho Tr i -
Cyclen. The study enrolled more than 500 women in each gro u p
for 6 months of treatment. Yasmin was superior in reduction of
total lesion counts and investigator’s assessment, but in re d u c-
tion of inflammatory lesions, the two were fairly equivalent.
The newest oral contraceptive approved for the management
of acne is dro s p i renone 3 mg and ethinyl estradiol
20 micrograms (YAZ). In one study, 431 people were
e n rolled and received either YAZ or placebo. There was
about a 50% mean percent change in inflammatory lesions
by the end of the sixth month of treatment. Since this was
m o n o t h e r a p y, 50% reduction is an impressive change.
ORAL CONTRACEPTIVE RISKS
One reason dermatologists may not prescribe oral contraceptives
for their acne patients is the risks associated with
birth control pills. These risks include venous thromboembolism,
stroke, myocardial infarction and breast cancer.
Venous thromboembolism. The risk of venous thromboembolism
is tripled in current users of oral contraceptives.
It is increased to 4 to 18 events per 10,000 woman-years.
The risk increases with higher doses of ethinyl estradiol. Also,
the mortality rate doubles in women aged 35 to 45.
Stroke. There is a 2.5x increase in ischemic stroke in
women age 20 to 24 who use birth control pills. Again, the
risk is directly proportional to the ethinyl estradiol dose.
Choose pills that have a lower dose of ethinyl estradiol. The
risk increases with age. It also increases when other risk factors,
such as cigarette smoking, hypertension and migraine
headaches, are present.
Myocardial infarction. Eighty percent of myocardial infarctions
that occur in women who are on birth control pills occur
in women who also smoke cigarettes, with the remainder
occurring in oral contraceptive users with other risk factors,
such as hypertension or diabetes.
Breast cancer. A large World Health Organization metaanalysis
looked at more than 53,000 women with breast cancer
and more than 100,000 controls. The relative risk of
breast cancer was 1.24 in current users of birth control pills
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