Acne and oral contraceptive pill

• some women find that their acne and/or hirsutism improves whilst taking the combined oral contraceptive pill
  
  
• the best response occurs if a pill is more oestrogenic - this is because the oestrogen in the pill causes raised levels of sex hormone binding globulin, which in turn binds with excess free androgen:
  
  • examples of oestrogenic pills include Brevinor, Marvelon and Ovysmen
    
    
• in severe cases Dianette may be considered (1,2,3):
  • co-cyprindiol (Dianette®) or other ethinylestradiol/cyproterone acetate containing products
    • licensed only for women with severe acne that has not responded to antibacterials and for treatment of acne in women with moderately severe hirsutism
    • risk of venous thromboembolism is higher in women taking co-cyprindiol than a low-dose COC - should not be used solely as a contraceptive and use of an additional hormonal contraceptive with co-cyprindiol is contraindicated (1)
    • whilst on treatment the patient should be evaluated regularly by a clinician and the patient advised to be vigilant for signs and symptoms of VTE
    • should be discontinued 3 months after acne has been controlled
    • for the individual product - consult the Summary of Product Characteristics and consider UK Medical Eligibility Criteria for Contraceptive Use

The respective summary of product characteristics must be consulted before prescribing any of the drugs mentioned above.

Reference:

• 1. Clinical Knowledge Summaries.Acne Vulgaris(accessed 6/2/2020)
• 2. Prescriber (2006); 14 (22): 44-55.
• 3. Wirral NHS University Teaching Hospital. Acne Vulgaris (accessed 6/7/16).