Adult Acne Treatment
NEW YORK -- July 31, 1997 -- Women suffering from adult onset acne or worsening acne during adult years, typically seek standard acne therapies such as topical preparations, antibiotics or Accutane. Unfortunately, about 60 percent of these women either do not respond to standard acne treatment or build up a tolerance to frequently used medications.
Anti-androgen and/or hormonal treatment of acne, limited to women,
offers a different approach that is proving helpful when other treatments are ineffective.
Speaking today at the American Academy of Dermatology's Academy
'97 Meeting, at the New York Hilton and Towers, James C. Shaw, MD, University of Chicago,
Department of Dermatology, discussed the expanding field of hormonal acne treatment.
It is not known what triggers adult onset acne. The development
of hormonal irregularities in the menstrual cycle may be a factor, or ovarian cysts may
cause hormonal abnormalities that increase androgen productivity, resulting in acne
Women who benefit most from hormonal treatment are typically in
their 20s or 30s, and have a history of failed treatment, or an intolerance to standard
acne therapies (both topical and systemic). In addition, many have a history of menstrual
irregularities, premenstrual acne flare-up, and facial oiliness. Hormonal treatment is
generally not used in the most severe forms of acne, nodular/cystic acne.
Most acne treatments require prolonged care, from months to
years. Once improvement is achieved, a maintenance dose is usually necessary. Women who
develop adult acne typically have the problem for years, frequently through menopause.
The modalities used most in hormonal acne treatment are oral
contraceptives and antiandrogens (spironolactone or flutamide).
"It is common to start with oral contraceptives for one to
two months," Dr. Shaw said. "Sometimes just regulating the menstrual cycle is
enough to stop the acne. Often women are already on birth control pills, so we add
antiandrogens. The combination is very effective."
The hormonal approach is becoming more mainstream, and it is not
uncommon to use the two hormones together.
Spironolactone is a medication used primarily for the treatment
of high blood pressure. Recently it has been used to treat acne and excess hair growth in
women. Spironolactone and flutamide act by blocking the effects of testosterone (androgen)
on the oil glands and hair follicle. It is the male hormone testosterone which triggers
the acne. The result is a reduction in oil production and facial hair growth, and the
improvement of acne and excessive hair growth.
The optimal dose of spironolactone varies in different
individuals and may require some adjustment. The benefits are usually apparent in two to
three months, but frequently within one month. This drug has been used for over 25 years
and has proven quite safe and is generally well tolerated.
Serious side effects with spironolactone are extremely rare. The
most common side effect is irregularity of menstrual cycles, but if the patient is taking
birth control pills, this should cause minimal problems, Dr. Shaw said.
In addition to clearing acne, spironolactone treats premenstrual
syndrome (PMS) and acts as a diuretic, which may counter some of the weight gain typical
of birth control pills.
The treatment goal is to control the acne with therapy and then
maintain that treatment as long as needed, with the lowest dose that controls the problem,
Dr. Shaw said. Some form of treatment may be necessary until menopause.
"The use of hormonal treatment in acne is very
individualized and usually requires considerable discussion with patients, with possible
adjustments of medications and doses during the first few months of treatment," Dr.
Shaw said. Once a stable level of control is achieved, patients tend to do quite
well on their own and follow-up visits may be as few as every six to 12 months.
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