II. Management: Hormonal Options for Women
- Change Oral Contraceptive if already taking one
- Increase Estrogen (50ug Ethinyl Estradiol minimum)
- Decrease to low androgenic Progestin
-
Oral Contraceptive with low androgenic Progestin
- Norgestimate
- Norethindrone
- Norlutin
- Aygestin
- Drospirenone
- Yasmin
- Beyaz or Safyral (with Levomefolate)
- Desogestrel
- Ethynodiol Diacetate
- Demulen
- Zovia
-
Spironolactone
- Use with Contraception due to SpironolactoneTeratogenicity
- Indications: Women with androgen hypersecretion
- Free Testosterone increased
- DHEA-S increased
- Dose: 50 to 200 mg orally daily
III. Management: Topical Androgen Receptor Inhibitor
- Winlevi (Clascoterone) 1% cream applied twice daily
- Topical Androgen Receptor Inhibitor indicated in acne for males or females
- May cause skin irritation
- Hypothalamic-Pituitary Axis suppression may be present as of 2 weeks of use
- Systemic effects (e.g. Amenorrhea, Hyperkalemia) are rare
- Efficacy data against standard, established acne medications is lacking
- Expensive (>$500 for 60 grams)
- (2021) Presc Lett 28(2): 12
IV. Management: Inflammatory Acne
- Visible Light Therapy decreases inflammatory acne
-
Topical Corticosteroids
- Moderate to high potency agents (Triamcinolone or Clobetasol)
- Limit to short-term use (less than 14 days) only
- Inflammatory lesions needing quick cosmetic therapy
- Indications
- Photo or modeling session
- Wedding or other life-event
- Technique
- Dilute Triamcinolone 10 mg/ml to 2-3 mg/ml
- Inject 0.1 cc into inflammatory acne lesion
- May repeat in 3-4 weeks up to one month
- Indications
V. References
- Habif (2004) Dermatology, Mosby, p. 162-94
- Kaplan (2001) CMEA Medicine Lecture, San Diego
- Parker in Noble (2001) Primary Care p. 758-60
- Brown (1998) Lancet 351:1871-6 [PubMed]
- Feldman (2004) Am Fam Physician 69:2123-56 [PubMed]
- Gollnick (2003) J Am Acad Dermatol 49:S1-37 [PubMed]