Acne affects about 70–80% of teenagers, with many continuing to suffer during adulthood. For some women with hormonal acne, it can be a very frustrating medical condition to treat and keep under control. There are many treatment options available for acne, both over-the-counter and prescription. One more recent treatment option discovered for acne is oral contraceptive pills.
Acne can be a life-long problem that is difficult and frustrating to treat.
Acne is caused by excess androgens that increase oil production. Excess oil, dead skin cells, and bacteria clog pores and result in acne lesions.
There are several treatment options for acne, such as oral contraceptives, which are especially helpful in hormonal acne cases.
Oral contraceptives have transient side effects and carry possible serious, long-term consequences to their use. Some women are not healthy enough to take them.
Always discuss side effects and whether you are healthy enough to take oral contraceptives with your doctor before starting.
What is acne?
Most patients do not realize that acne is not a true infection. While bacteria make acne worse, acne is an inflammation of the pilosebaceous unit, which consists of the hair follicles, pores, and oil glands. When hormones fluctuate and lead to an increase in androgens, this causes oil glands to enlarge and produce more oil.
The excess oil clogs the pores and causes dead skin cells to get stuck inside the pores too. This leads to whiteheads and blackheads. If bacteria get trapped inside the clogged pores also, this produces tender, inflammatory acne bumps. These lesions can become large cysts that cause significant pain and can leave permanent scars.
What causes acne?
Acne is caused by a fluctuation in hormones that results in excess androgen production. Androgens are sex hormones that are precursors to testosterone. When androgens surge during puberty, they cause oil gland enlargement and excess oil production.
If you are taking certain medications, such as progesterone-only birth control pills also known as "mini-pill" or testosterone replacement therapy, that can cause acne. Progesterone and testosterone can increase oil production leading to acne. The combination of estrogen and progesterone in some oral contraceptives can help keep acne under control.
Stress causes the release of the hormone cortisol. Cortisol is also responsible for the increase in oil production. This excess oil production clogs the pores and causes acne.
Certain foods have been linked to acne, like dairy and sugars. Both cause inflammation in the body and excess oil production. More recently whey protein, since it is derived from milk, has been linked to acne as well.
Treatment options for acne
There are many different treatment options ranging from over-the-counter topicals to prescription medications and professional treatments.
|Over-the-counter products||Salicyclic acid, benzoyl peroxide, adapalene|
|Prescription topicals||Antibiotics (clindamycin, erythromycin, and sulfa) or retinoids (adapalene, tretinoin, and tazarotene)|
|Prescription pills||Antibiotics (tetracycline, doxycycline, minocycline, and azithromycin), retinoids (isotretinoin), and hormones (spironolactone and oral contraceptives, like Ortho Tri-cyclen and Yaz).|
|Lasers and light||AviClear, blue and red light, IPL with PDT, and Neo Elite|
|Peels||Salicylic acid, retinoids, and glycolic acid|
Acne treatment with oral contraceptives
Oral contraceptives that contain a combination of estrogen and progesterone can help treat acne by keeping androgens under control. With fewer androgens, the oil glands will shrink and produce less oil resulting in less acne. This type of hormonal therapy for acne is especially helpful for the stubborn acne that occurs on the chin and jawline.
How long it takes before oral contraceptives help acne?
As with any acne therapy, it takes time to see good results. Oral contraceptives can take 2–3 months to see their benefits on acne. Studies comparing long-term oral contraceptive use to oral antibiotics for acne found equal results without the worry of bacterial resistance developing from long-term antibiotic use.
Oral contraceptives & other acne treatments
Oral contraceptives can be combined with other acne treatments to get faster or better results in severe cases. These treatments include over-the-counter topicals, prescription topical and oral antibiotics, and peels.
Care must be exercised when combining oral contraceptives with oral antibiotics because some antibiotics may decrease the efficacy of oral contraceptives in preventing pregnancy.
Also, estrogens may make you photosensitive, so they may not be combined with some laser or light treatments. You should discuss combination treatments with your doctor before starting.
Side effects of oral contraceptives
While oral contraceptives are great at preventing pregnancy and may help some cases of acne, they do have side effects. Some are transient, but others are more serious and can cause long-term health issues. You should discuss them with your doctor before starting.
Here are the some of the side effects of oral contraceptives:
- Gastrointestinal. Nausea, vomiting, abdominal pain, or liver or gallbladder disease.
- Weight. Weight gain has been reported.
- Swollen breasts. The breasts can become swollen and tender.
- Spotting. Small amounts of blood being present between periods.
- Lighter bleeding. There have been reports of much lighter periods.
- Mood. Depression and mood changes have been noted.
- Headaches. There is a risk of headaches and potentially migraines.
- Cardiovascular. There is a greater risk of high blood pressure, heart attack, stroke and blood clots.
Who should not take oral contraceptives?
Since oral contraceptives can cause serious health issues in some patients, they may not be able to be used by everyone. Here are some of the factors that indicate who should not take oral contraceptives:
- Heart disease or high blood pressure
- Breast, uterine, or liver cancer
- Diabetes mellitus
- Pregnant or breastfeeding
- Certain medications, like steroids, anticonvulsants, or antibiotics
- Blood clots
- Liver disease
- Severe obesity
- Smokers over 30
Oral contraceptives that combine estrogen and progesterone have recently been found to help treat hormonal acne. They are a great treatment option for those women who want to prevent pregnancy and treat their acne. However, they do carry some serious side effects and must be discussed with your doctor before starting. Patients with some medical conditions must not use an oral contraceptive, so you must also discuss with your doctor if you are healthy enough to take them.
- International Journal of Women's Health. Examining the use of oral contraceptives in the management of acne.
- Dermatology Clinics. Use of oral contraceptives for management of acne vulgaris: Practical considerations in real world practice.
- Journal of Drugs in Dermatology. Hormonal contraceptives and acne: A retrospective analysis of 2147 patients.
- Journal of the American Academy of Dermatology. Approaches to limit systemic antibiotic use in acne: Systemic alternatives, emerging topical therapies, dietary modification, and laser and light-based treatments.