Acne & Contraceptives
Around 85 percent of teens will get acne at some point, says the American Academy of Dermatology (AAD). But women have an extra option to help clear their skin as oral contraceptives can be effective, according to a 2009 analysis of medical studies published in the influential Cochrane Database.
Four factors cause acne: excess sebum (the oil produced by the sebaceous glands below the skin's surface), overgrowth of acne-causing bacteria, clogged pores and inflammation. The four factors work in concert to produce pimples, blackheads and whiteheads. According to the AAD, oral contraceptives target excess sebum production. Physicians generally prescribe oral contraceptives for women with acne that has proven resistant to treatment with antibiotics.
High levels of hormones called androgens can cause acne in women, and this acne often is resistant to treatment with antibiotics. Androgens cause excess sebum oil production. When a woman takes oral contraceptives, the hormones in the pill (estrogen and progestin) balance her levels of androgens. This causes her sebaceous glands to produce less sebum oil, which then reduces the number of clogged pores that develop.
According to the AAD, brands of oral contraceptives that include both estrogen and progestin can help control acne. The U.S. Food and Drug Administration has approved two oral contraceptives, Ortho Tri-Cyclen and Estrostep, for use in acne treatment, but physicians use a variety of different brands. In the Cochrane Database review of the medical literature on acne and oral contraceptives, researchers examined 25 different medical studies evaluating different pills, all of which contained both estrogen and progestin. They found few differences in effectiveness between pills.
The AAD warns that oral contraceptives take time to start clearing up acne. Women should begin to see some improvement within about three months of going on the pill, and some women actually see their acne get worse before it gets better. In addition, missing doses can cause fluctuating levels of hormones, which will make the oral contraceptives less effective in treating acne.
Because oral contraceptives only target one of the four causes of acne--excess sebum oil production--dermatologists often combine oral contraceptive acne treatment with other treatment, according to the AAD. Oral contraceptives are considered a "second-line" treatment for acne, which means your dermatologist most likely will try other drugs, such as antibiotics and/or strong benzoyl peroxide treatments, before prescribing oral contraceptives to treat acne.
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