COCs and acne. (Clinical Challenges).

An 18-year-old client seeks contraception at a family planning clinic. After family planning counseling, she opts for combined oral contraceptives (COCs), primarily for their convenience. The client, you notice, has marked facial acne. She explains that she began experiencing the acne about three months before and was just considering seeing a doctor for advice about treating it. Would COCs be advisable for contraception and also be helpful in controlling her acne?

Low-dose COCs not only serve for contraception but also reduce acne, a common dermatological problem for adolescents that can leave both psychological and physical scars. Acne can be treated by reducing the effect of androgen in the body, (13) either directly (with anti-androgen) or indirectly (with estrogen). Estrogen reduces the availability of active free androgen by increasing sex hormone-binding globulin in the blood, and several randomized controlled trials have found COCs to improve acne when compared with placebos. (14) Similarly, combinations of lowdose estrogens and such progestins as cyproterone or drospirenone are effective in treating acne and providing contraception at the same time. (15)

The questions above were angered by Dr. David Grimes, vice president of biomedical affairs at FHI, and Dr. Ayodele Arowojolu, an FHI clinical research fellow in contraceptive technology who is on leave from his position as senior lecturer/consultant in obstetrics and gynecology at the College of Medicine, University of Ibadan, Nigeria. The FHI Fellowship program, based in Research Triangle Park, North Carolina, USA, aims to increase the number of qualified clinical researchers in contraceptive technology worldwide, and to establish a collegial relationship between FHI and the fellows' sponsor institutions.

(13.) Slayden SM, Moran CM, Sams WM Jr, et al. Hyperandrogenemia in patients presenting with acne. Fertil Steri12001;75(5):889-92.

(14.) Lucky AW, Henderson TA, Olson WH, et al. Effectiveness of norgestimate and ethinyl estradiol in treating moderate acne vulgaris. J Am Acad Dermatol 1997;37(5):746-54; Redmond GE Effectiveness of oral contraceptives in the treatment of acne. Contraception 1998;58(3 Suppl):29S-33 S; Thiboutot D, Archer DF, Lemay A, et al. A randomized, controlled trial of a low-dose contraceptive containing 20 [micro]g of ethinyl estradiol and 100 Fg of levonorgestrel for acne treatment. Fertil Steril 2001;76(3):461-68; Redmond GP, Olson WH, Lippman J S, et al. Norgestimate and ethinyl estradiol in the treatment of acne vulgaris: a randomized, placebo-controlled trial. Obstet Gynecol 1997 ;89(4):615-22.

(15.) van Vloten WA, van Haselen CW, van Zuuren EJ, et al. The effect of two combined oral contraceptives containing either drospirenone or cyproterone acetate on acne and seborrhea. Cutis 2002;69(4 Suppl):2-15.