Add another 'acne pill' to list of current OCs

The next patient in your examination room is an adolescent female who says she wants the "acne pill." What are your options?

While all combined oral contraceptives (OCs) prevent acne through several mechanisms, three pills now carry approved acne indications from the Food and Drug Administration (FDA). Yaz, a 20 mcg ethinyl estradiol/3 mg drospirenone pill from Berlex of Wayne, NJ, just received FDA approval for the acne indication. It joins Ortho Tri-Cyclen (Ortho-McNeil Pharmaceutical, Raritan, NJ) and Estrostep Fe (Warner Chilcott; Rockaway, NJ). Ortho Tri-Cyclen uses a combination of ethinyl estradiol and norgestimate, while Estrostep uses a formulation of ethinyl estradiol and norethindrone acetate, with seven days of ferrous fumarate.

Yaz, an oral contraceptive with 24 days of active hormones and four days of placebo pills, was approved for contraceptive use in March 2006. It also carries an indication for the treatment of emotional and physical symptoms of premenstrual dysphoric disorder.

Drospirenone is unique among contraceptive steroids in that it is an anti-androgen and therefore inhibits the action of androgens on target tissues, says Ian Thorneycroft, PhD, MD, professor of obstetrics and gynecology at the University of South Alabama in Mobile. Additionally, it inhibits ovulation, thereby reducing ovarian androgen production. Combined with estrogen in an oral contraceptive, it increases sex hormone-binding globulin, thus reducing free testosterone.

According to Berlex, two six-month multicenter, double-blind, placebo-controlled, randomized clinical trials of more than 1,000 patients were conducted to assess the safety, efficacy, and tolerability of Yaz in treating moderate acne. Treatment with the study drug resulted in significant reductions in total, inflammatory, and noninflammatory acne lesion counts, states the company. The study drug was well tolerated by most women in these clinical studies, with the most common side effects including upper respiratory infection, irregular bleeding, headache, nausea, sinusitis, and yeast infection.

Posters of the data will be presented by J. Michael Maloney, MD, of Cherry Creek Research in Denver at the American College of Obstetricians and Gynecologists (ACOG) annual clinical meeting in May 2007, says Rose Talarico, Berlex spokeswoman. Results of the trials have not been published, she states.

Review Pill's effects

It is no surprise that patients may seek treatment when it comes to acne; it affects 85% of people ages 15 to 24.1 Use of oral contraceptives represents one strategy in treating mild to moderate cases of the dermatologic condition.

Combined OCs prevent acne by reducing the production of the androgen testosterone by suppressing luteinizing hormone.2 Androgen bioavailability also is reduced due to an increase in the level of sex hormone-binding globulin, which binds free androgens. Oral contraceptives act on multiple sites to decrease the total and free androgen levels, ultimately leading to a reduction in sebum production.1 The Pill has been the focus of several studies in acne treatment3 and has been shown to be effective alone or in combination with other oral or topical treatments.

Adolescent patients who seek acne treatment may feel embarrassed about using a "birth control" pill. How can you counsel for method success? Take a look at the following suggestions4:

  • Discuss the fact that the Pill is a medical treatment, similar to drugs that are prescribed for other medical conditions. Consider the drug as a "hormone pill."
  • Remind the adolescent that the Pill has additional noncontraceptive benefits, including period regulation, correction of hormonal imbalances, reduction of hirsutism, and prevention of iron deficiency anemia, pelvic inflammatory disease, and ectopic pregnancy. Oral contraceptives also help to decrease the risk of ovarian and endometrial cancers.

References

  1. Deitch HR, Hillard PJA. A gynecologist's guide to acne. Contemporary OB/GYN 2002; 1:88-99.
  2. Thorneycroft IH, Stanczyk FZ, Bradshaw KD, et al. Effect of low-dose oral contraceptives on androgenic markers and acne. Contraception 1999; 60:255-262.
  3. Arowojolu AO, Gallo MF, Grimes DA, et al. Combined oral contraceptive pills for treatment of acne. Cochrane Database Syst Rev 2004; 3:CD004425.
  4. Reproductive health issues for adolescents. Contraception Report 1997; 8:13-14.