Oral contraceptives are a good option for women’s acne: study

Birth control pills seem to work as well as antibiotics for long-term treatment of acne in women, according to a new review of past clinical trials.

After six months, both treatments reduced acne by just over 50 percent, prompting dermatologists to call the Pill a good alternative for some women and a means of avoiding the drawbacks of stronger oral acne medications or long-term antibiotic use.

Past research has shown that both antibiotics and birth control pills can improve acne, but the new review compared the two options side-by-side and found antibiotics worked better after three months, but after six months of use, results were about equal.

“Oral contraceptives (OCPs) take longer to work because they have a different mechanism of action,” said Dr. Kelly H. Tyler, who was not involved in the new review.

“Antibiotics have anti-inflammatory properties, and OCPs do not have those same properties, so the reduction in acne is going to be more gradual and less dramatic in the beginning,” said Tyler, a dermatologist at Ohio State University in Columbus.

Antibiotics help to reduce inflammation of existing acne, whereas oral contraceptives reduce free or circulating androgens, lowering production of the oily sebum that plugs pores, which lowers the risk of new acne developing, she told Reuters Health by email.

The review included 32 randomized controlled trials of antibiotics or oral contraceptives for treating acne. In general, after three months of treatment, antibiotics had reduced the number of whiteheads or cysts by 48 percent, compared to 37 percent with oral contraceptives.

But by six months, oral contraceptives had caught up, reducing acne by 55 percent, compared to 53 percent with antibiotics, according to the results published in the Journal of the American Academy of Dermatology.

The authors caution that the antibiotics trials they analyzed included both men and women, which interferes with the comparison to the contraceptive trial results because hormones do play such an important role in acne.

Nonetheless, they write, the findings suggest birth control pills “may have a more important first-line preventive role in chronic acne than previously accepted.”

Dr. Steven R. Feldman, a dermatologist at Wake Forest University School of Medicine in Winston-Salem, North Carolina, agreed. “This confirms that birth control pills are a good solid treatment for acne, and they’re probably underutilized,” he told Reuters Health.

The Food and Drug Administration has approved many birth control medications for treating acne as well as preventing pregnancy, so there should be no barrier to prescribing them, but dermatologists may still be reluctant, said Feldman, who was not involved in the new study.

Dermatologists often recommend low-dose hormonal birth control as an option for female patients, but don’t actually write a prescription for it, he told Reuters Health. Then the patient returns to her primary care doctor, who may write the prescription, and when the acne clears up the patient does not return to the dermatologist.