| Acne, often thought to be only a | | | | Oral Contraceptives (OCs)OCs, which |
| teenager's skin problem, is actually a | | | | contain estrogen and progestins, |
| condition that can affect adults both | | | | directly affect how much androgen your |
| male and female, although it generally | | | | body produces and can therefore impact |
| begins during puberty. Taking a | | | | acne. Possible ways that estrogens may |
| proactive approach to treating acne is | | | | be working to improve acne include: |
| very important. How you look after your | | | | Decreased production of adrenal (DHEA-S) |
| skin every day, along with the treatment | | | | and ovarian androgens (A, T); |
| you and your doctor select are key steps | | | | Inhibition of the enzyme |
| in your fight to eliminate pimples, | | | | 5-alpha-reductase, which leads to a |
| preventing scarring and eliminating your | | | | reduction of DHT levels; |
| acne. | | | | SHBG increase, which reduces levels of |
| There are a number of acne medications | | | | T. |
| that can be used to treat your acne | | | | Progestins vary in their androgenic or |
| including over-the-counter acne products | | | | testosterone-like activity and may, |
| like Panoxyl®, or prescription | | | | therefore, have variable effects on |
| drugs including topical treatments, | | | | acne. Progestins with the lowest |
| Accutane® and hormone therapies. | | | | androgenic activity are more appropriate |
| | | | in the treatment of acne and other |
| Hormonal treatments, including oral | | | | disoders caused by increased androgen |
| contraceptives, have long been | | | | levels (desogestrel, norgestimate). |
| recognized by dermatologists to be an | | | | Alternatively, cyproterone acetate - an |
| effective treatment option for women who | | | | antiandrogenic progesterone derivative - |
| have acne, no matter how severe. | | | | may be combined with the estrogen |
| Acne is thought to be initiated by the | | | | component. |
| effect of masculinising hormones called | | | | Currently available OCs such as |
| "androgens" on oil glands that, during | | | | Diane-35®, Tri-Cyclen®, |
| puberty, enlarge and become increasingly | | | | Alesse®, and Yasmin® |
| sensitive. This results in excessive oil | | | | contain progestins with minimal |
| secretion and blockage of pores, which | | | | androgenic or anti-androgenic activity, |
| leads to the initial non-inflamed spots | | | | providing an important therapeutic |
| of acne (whiteheads and blackheads). As | | | | option for women with acne. Their proven |
| the acne bacteria (Propionibacterium | | | | effectiveness and long-term safety |
| acnes) proliferate, the oil-rich | | | | profile supports their use in various |
| environment in the pores leads to | | | | grades of acne in females: |
| inflammation which becomes visibly | | | | as additional therapy with topical |
| apparent as red pimples, pustules and | | | | agents for women who have mild, |
| lumps. | | | | non-scarring acne and who desire oral |
| Hormonal therapy for acne is, therefore, | | | | contraception; |
| meant to interrupt this initial phase of | | | | as primary therapy in moderate, |
| this cascading sequence of acne | | | | non-scarring acne in combination with |
| development. Such preparations include | | | | topical therapy and systemic |
| oral contraceptives such as | | | | antibiotics; |
| Diane-35®, Tri-Cyclen®, | | | | in scarring and severe inflammatory acne |
| Alesse®, and Yasmin®; | | | | as one of two preferred methods of |
| and a non-contraceptive anti-androgen, | | | | contraception in patients treated with |
| spironolactone. To learn more about | | | | systemic isotretinoin. |
| hormones and acne, click on Other | | | | Clinical studies in acne patients |
| Hormone Therapy. | | | | treated with Tricyclen and Alesse show |
| Possible Relationships Between Hormones | | | | that acne spots were reduced by 40-50% |
| and Acne Androgens that play a part in | | | | over a course of 6 months. The extent of |
| causing acne include | | | | improvement may be greater with Diane-35 |
| 5-dihydrodrotestosterone (DHT), | | | | as patients in a Canadian acne survey |
| testosterone (T), androstenedione (A), | | | | generally considered Diane-35â to |
| and dehydroepiandrosterone-sulfate | | | | be more effective for treating acne than |
| (DHEA-S). The production of these | | | | Tricyclenâ. Side effects common |
| androgens from ovaries and adrenal | | | | to all oral contraceptive preparations |
| glands is mediated by gonadotrophins. | | | | included breast tenderness, headache, |
| Levels of testosterone are inversely | | | | and nausea. These were typically mild |
| related to levels of sex hormone binding | | | | and tended to resolve by the second |
| globulin (SHBG), so that if T increases, | | | | cycle. A newly approved oral |
| SHBG decreases and when T is reduced, | | | | contraceptive in Canada, Yasminâ, |
| SHBG increases. | | | | has been shown to be as effective as |
| Polycystic ovarian syndrome is a | | | | Diane-35â for treating acne. |
| condition found in women who have very | | | | SpironolactoneSpironolactone, a |
| high androgen and testosterone levels. | | | | synthetic steroid, is an anti-androgen |
| Symptoms include obesity, infertility, | | | | that binds to the body's androgen |
| scalp hair loss, increased facial and | | | | receptors, thus blocking the androgens |
| body hair, irregular periods, acne and | | | | from binding to the cell receptors, |
| elevated blood insulin levels. This | | | | inhibits 5-alpha-reductase enzyme |
| condition affects 5-10% of women in | | | | activity and reduces androgen |
| their reproductive years. Clinical | | | | biosynthesis. Small studies using this |
| evaluation and blood testing can be | | | | agent for treating acne have been shown |
| performed to diagnose this disorder. In | | | | to be effective with few side effects, |
| addition to exercise and weight control, | | | | but larger studies are needed for |
| hormonal therapy is often helpful in | | | | confirmation. |
| this condition. | | | | |