Examining the impact of contraception on acne in adolescents is clinically important because acne affects about 85% of adolescents, and contraceptives may influence the course of acne disease. Estrogen-progestin contraceptives cause a significant improvement in acne.1,2 By contrast, the levonorgestrel-releasing intrauterine device and the etonogestrel contraceptive implant may exacerbate acne. In this editorial we review the hormonal contraception−acne relationship, available acne treatments, and appropriate management.
Combination oral contraception and acne
As noted, combination oral contraceptives generally result in acne improvement.1,2 Estrogen-progestin contraceptives improve the condition through two mechanisms. Primarily, estrogen-progestin contraceptives suppress pituitary luteinizing hormone secretion, thereby decreasing ovarian testosterone production. These contraceptives also increase liver production of sex hormone-binding globulin (SHBG), thereby increasing bound testosterone and decreasing free testosterone. The decrease in ovarian testosterone production and the increase in SHBG-bound testosterone reduce sebum production, resulting in acne improvement.
The US Food and Drug Administration has approved 4 estrogen-progestin contraceptives for acne treatment:
- Estrostep (norethindrone acetate-ethinyl estradiol plus ferrous fumarate)
- Ortho Tri-Cyclen (norgestimate-ethinyl estradiol)
- Yaz (drospirenone-ethinyl estradiol)
- BeYaz (drospirenone-ethinyl estradiol plus levomefolate).