Oral contraceptives and cyproterone acetate in female acne treatment

The sebaceous gland is a target of androgens, and hormonal influences play an important role in the multifactorial pathogenesis of acne. In both men and women, acne may be related to an excessive hypersensitivity of the sebaceous end organ to androgens. However, in women, the ovarian and adrenal production and the plasma transport of androgens may be implicated, particularly in late-onset or persistent acne or with associated hirsutism. Many reports have shown that females with acne frequently have abnormal levels of circulating androgens. Hormonal treatment is not usually the first line in female acne. But in relation to the possibilities, particularly the tetracyclines, this may be a choice when one prescribes a pill like Dianette(R) to a young woman presenting a mild acne and who requests contraception. However, antiandrogen treatment is sometimes mandatory, especially in resistant acne in adult women and/or in female acne which is resistant or relapsing rapidly after treatment with Roaccutane(R) and which is often related to hyperandrogenism. Finally, in severe prepubertal acne, the possible cause is an adrenal enzymatic block of which the only treatment is hormonal.