Women and Acne

Spironolactone and cyproterone acetate

Androgen receptor blockers - hormonal therapy

Spironolactone

spironolactone What it is: Women who experience acne tend to have higher levels of androgens (male sex hormones). Spironolactone is an androgen receptor blocker. In other words, it prevents the cells of the body from interacting with androgens. Less androgens typically means less acne.1-3 Spironolactone is taken in pill form and can be used with other topical acne treatments, as well as in conjunction with birth control pills. It is especially effective when hirsutism is present. Hirsutism means excessive hair growth in women. Spironolactone is also used to treat this condition.4

Study results: Spironolactone has shown mixed results in several studies, both on its own and coupled with oral contraceptives. In a study published in the Journal of the American Academy of Dermatology in 2008, 85% of women achieved very good results with a combination of spironolactone and an oral contraceptive with drospirenone.5 Another study published in the Journal of the European Academy of Dermatology and Venereology showed "clinically significant improvement" in 85.71% of subjects taking spironolactone alone.6 However, other studies have shown no significant decrease in acne symptoms when using spironolactone alone. Due to the small number of studies in this area, and their conflicting results, the authors of a meta-analysis in 2009, published in The Cochrane Library, conclude, "there [is] no evidence for the effectiveness of [spironolactone] for the treatment of acne vulgaris."3

Side effects: Side effects are common. Studies show upwards of 50% of women experiencing menstrual irregularities. Spironolactone may create breast tenderness, headache, or fatigue, and can also have a diuretic effect. In pregnant women, feminization of the male fetus is also possible.6 However, an 8-year study published in the Journal of Cutaneous Medical Surgery concluded, "...there were no cases of serious illness attributable to spironolactone use."7

Note: Asian women sometimes respond differently to hormonal treatment. However, a study using 116 Japanese women completed in 2006 showed that "...spironolactone is effective and safe for the treatment of acne in Asian females."8

Men: Spironolactone is usually reserved for use in females because gynecomastia (breast growth) can occur in males who take the drug.

Spironolactone member reviews

Cyproterone acetate

diane-35 What it is: Acne-prone women tend to have higher levels of androgens (male sex hormones). Cyproterone acetate is an anti-androgen, which helps suppress the male sex hormones testosterone and dihydrotestosterone (DHT). Less androgens typically means less acne.9 Cyproterone acetate is administered in pill form and also sometimes as a lotion. In both forms it has been shown to reduce sebum (skin oil) production. It can normally be used alongside other topical acne treatments. It is also used to treat polycystic ovary syndrome, excessive hair growth (hirsuitism), alopecia, and other diseases where androgen action is involved. Cyproterone acetate is a main ingredient in Diane-35, a popular oral contraceptive in Europe and Canada.

Study results: Two studies so far have shown 75%-90% of women experiencing an improvement in acne symptoms when taking cyproterone acetate alone.10-11 Another study found that women using Diane-35, which is cyproterone acetate plus ethinyl estradiol, saw a 58.8% decrease in total acne lesion count.12

Side effects: The most notable side effect is liver toxicity. In combination with oral contraceptives, there is an increased risk of blood clots. Osteoporosis is also a potential side effect with long-term use.

Note: Asian women sometimes respond differently to hormonal treatment. If you are of Asian descent, be sure to ask your doctor if he/she is aware of your particular circumstance before embarking on treatment.

Men: Cyproterone acetate is usually reserved for use in females because gynecomastia (breast growth) and galactorrhea (milk production) may occur in males who take the drug.

Diane-35 (oral contraceptive plus cyproterone acetate) member reviews

References

1. “Frequently Asked Questions: Acne.” Womenshealth.gov. 1 Jan. 2005. National Women’s Health Information Center. 8 Jan 2009. link.

2. Chuan SS and Chang RJ. "Polycystic ovary syndrome and acne." Skin Therapy Letter. 2010; 15(10): 1-4.

3. Brown J, et al. "Spironolactone versus placebo or in combination with steroids for hirsutism and/or acne." The Cochrane Library. 2011; 4.

4. Farquhar C, et al. "Spironolactone versus placebo or in combination with steroids for hirsutism and/or acne." Comment in American College of Physicians Journal Club. 2004; 140(3): 74.

5. Krunic A, Ciurea A and Scheman A. “Efficacy and tolerance of acne treatment using both spironolactone and a combined contraceptive containing drospirenone.” Journal of the American Academy of Dermatology. 2008; 58(1): 60-2.

6. Yemisci A, Gorgulu A and Piskin S. “Effects and side-effects of spironolactone therapy in women with acne.” Journal of the European Academy of Dermatology and Venereology. 2005; 19(2): 163-6.

7. Shaw JC and White LE. “Long-term safety of spironolactone in acne: results of an 8-year followup study.” Journal of Cutaneous Medicine and Surgery. 2002; 6(6): 541-5.

8. Sato K, et al. “Anti-androgenic therapy using oral spironolactone for acne vulgaris in Asians.” Aesthetic Plastic Surgery. 2006; 30(6): 689-94.

9. Katsambas AD and Dessinioti C. "Hormonal therapy for acne: Why not as first line therapy? Facts and controversies." Clinics in Dermatology. 2010; 28(1): 17-23.

10. Van Wayjen RG and Van Den Ende A. "Experience in the long-term treatment of patients with hirsutism and/or acne with cyproterone acetate-containing preparations: Efficacy, metabolic and endocrine effects." Experimental and Clinical Endocrinology & Diabetes. 1995; 103(4): 241-251.

11. Gollnick H, Albring M and Brill K. "The effectiveness of oral cyproterone acetate in combination with ethinyl estradiol in acne tarda of the facial type." Annales d'endocrinologie. 1999; 60(3): 157-166.

12. Ebede TL, Arch EL and Berson D. "Hormonal Treatment of Acne in Women." The Journal of Clinical and Aesthetic Dermatology. 2009; 2(12): 16-22.

Further Reading

Shaw JC. “Low-dose adjunctive spironolactone in the treatment of acne in women: a retrospective analysis of 85 consecutively treated patients.” Journal of American Academy of Dermatology. 2000; 43(3): 498-502.

Turowski CB and James WD. “The efficacy and safety of amoxicillin, trimethorprim-sulfamethoxazole, and spironolactone for treatment-resistant acne vulgaris.” Advances in Dermatology. 2007; 23: 155-63.