The role of combined oral contraceptives in the management of acne and seborrhea

Oral Spironolactone for Acne Vulgaris in Adult Females: A Hybrid Systematic Review

BACKGROUND

The management of acne in adult females is problematic, with many having a history of treatment failure and some having a predisposition to androgen excess. Alternatives to oral antibiotics and combined oral contraceptives (COCs) are required.

OBJECTIVE

Our aim was to conduct a hybrid systematic review of the evidence for benefits and potential harms of oral spironolactone in the management of acne in adult females.

METHODS

The review was conducted according to a previously published protocol. Three reviewers independently selected relevant studies from the search results, extracted data, assessed the risk of bias, and rated the quality of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

RESULTS

Ten randomized controlled trials (RCTs) and 21 case series were retrieved. All trials were assessed as being at a 'high risk' of bias, and the quality of evidence was rated as low or very low for all outcomes. Apart from one crossover trial that demonstrated statistical superiority of a 200 mg daily dose versus inflamed lesions compared with placebo, data from the remaining trials were unhelpful in establishing the degree of efficacy of lower doses versus active comparators or placebo. Menstrual side effects were significantly more common with the 200 mg dose; frequency could be significantly reduced by concomitant use of a COC. Pooling of results for serum potassium supported the recent recommendation that routine monitoring is not required in this patient population.

CONCLUSION

This systematic review of RCTs and case series identified evidence of limited quality to underpin the expert endorsement of spironolactone at the doses typically used (≤100 mg/day) in everyday clinical practice.

Effects of an oral contraceptive containing estradiol valerate and dienogest on circulating androgen levels and acne in young patients with PCOS: an observational preliminary study

This study shows the effect of a 1 year treatment with an estradiol valerate/dienogest pill in 36 women suffering from polycystic ovaries and mild or moderate acne. At beginning of the study, 24 patients (66.7%) had grade 1-2 (mild) acne and 12 patients (33.3%) had grade 3 (moderate) acne. After 12 cycles of therapy, we found an improvement of acne in 19 (52.8%) patients and a worsening of acne in 3 (8.4%) patients. The percentage of patients recovered was statistically significant (p < 0.01). SHBG levels were significantly higher after 6 and 12 months of therapy (p < 0.001), while total testosterone levels were lower in all patients at 6 and 12 months although this trend did not reach statistical significance. In conclusion, the present study suggests that the E2V/DNG pill could exert a positive influence on acne and hyperandrogenism. Since this is an observational study on a very limited population number, additional randomized controlled studies on larger populations are needed also to determine the effects of this contraceptive over longer periods of use.

Hyperandrogenic women treated with a continuous-regimen oral contraceptive

OBJECTIVES

To investigate the effects of a continuous-regimen combined oral contraceptive (COC) on hyperandrogenic women.

STUDY DESIGN

This prospective study enrolled 52 women with moderate to severe hirsutism, as well as acne and seborrhea. Women were placed on a 192-day continuous regimen. To assess hirsutism, the modified Ferriman-Gallwey (mF-G) scoring system was used. Acne and seborrhea were defined by the Cremoncini scale. Serum FSH, LH, estradiol, total testosterone, FAI, DHEAS, androstenedione, SHBG and fasting insulin were measured at baseline and at the endpoint. One-way ANOVA was used to compare serum hormone levels and hirsutism scores at baseline with those obtained at the endpoint.

RESULTS

A reduction of 78.5% in the mF-G scores was observed at the endpoint (p<0.001). Women underwent improvement of acne and seborrhea, -58.7% and -56%, respectively (p<0.001). An evident decrease in both total testosterone and FAI, and an increase in SHBG were shown (p<0.001).

CONCLUSIONS

A COC continuous-regimen improved the esthetic effect of hyperandrogenism.

Women's knowledge of health effects of oral contraceptives in five Brazilian cities

BACKGROUND

Although acceptability of combined oral contraceptives (COCs) is widespread, patients are often unaware of the noncontraceptive benefits.

STUDY DESIGN

An opinion survey through telephone interview was conducted to evaluate the knowledge of 500 Brazilian women 15-45 years of age who were current users or had recently used COCs. Data were obtained on their knowledge of adverse events, the effects of COCs on health- and menstrual-related symptoms, noncontraceptive benefits and aspects related to sexual response.

RESULTS

Most of the women interviewed learned about the pill from doctors or the Internet. Other than the pill, the best-known contraceptive methods were the condom and intrauterine device. The majority of women believe that COCs do not change the risk of gynecological cancers. Most believed that they had no significant effect on sexual response.

CONCLUSIONS

COCs users in Brazil lack precise information on aspects related to general health, particularly menstrual-related symptoms and noncontraceptive health benefits.

Topically applied L-carnitine effectively reduces sebum secretion in human skin

BACKGROUND

  Oily skin condition is caused by an excessive sebaceous gland activity, resulting in an overproduction of sebum, giving the skin an undesired shiny, oily appearance.

AIMS

  To identify an active substance that reduces sebum production in human sebaceous glands by regulating fat metabolism in a natural way.

PATIENTS/METHODS

  The effects of L-carnitine on β-oxidation and intracellular lipid content were investigated in vitro using the human sebaceous cell line SZ95. Penetration experiments utilizing pig skin as a model system were performed with a cosmetic formulation containing radioactively labeled L-carnitine. To determine the in vivo effects, a vehicle-controlled, randomized study was carried out using a cosmetic formulation containing 2%l-carnitine for 3 weeks. Sebum production was investigated utilizing the lipid-absorbent Sebutape(®).

RESULTS

  SZ95 cells treated with 0.5% or 1% L-carnitine demonstrated a significant concentration-dependent increase in β-oxidation compared to control cells. Following the treatment with L-carnitine, intracellular lipid concentrations decreased significantly in a dose-dependent manner compared with untreated control cells. In skin penetration experiments, topically applied L-carnitine reached the dermis. In addition, topical in vivo application of a formulation containing 2% L-carnitine for 3 weeks significantly decreased the sebum secretion rate compared to the treatment with vehicle.

CONCLUSIONS

  Our results show that the treatment of human sebocytes with L-carnitine significantly augments β-oxidation and significantly decreases intracellular lipid content in human sebocytes. Topically applied L-carnitine is bioavailable and leads to a significant sebum reduction in vivo. In conclusion, L-carnitine represents a valuable compound, produced naturally within the body, for the topical treatment of oily skin in humans.

The effect of a phasic oral contraceptive containing Desogestrel on seborrhea and acne

OBJECTIVE

To investigate the effect of an oral contraceptive (Novial) on facial seborrhea and moderate acne.

METHODS

In this nonrandomized, group-comparative trial, women aged between 18 and 30 with seborrhea were enrolled. Women used either a phasic oral contraceptive containing ethinylestradiol (35/30/30 microg) and Desogestrel (50/100/150 microg (DSG-OC)) (n = 177) or no hormonal treatment (control group; n = 77) for four cycles.

RESULTS

Overall, 161 subjects (90.9%) in the DSG-OC group and 73 subjects (94.4%) in the control group completed the study. In the DSG-OC group, the total score for sebum excretion decreased by 0.71 nL/cm(2) (95% CI 0.36-1.05). In the control group, sebum excretion increased by 0.05 nL/cm(2) (-0.55 to 0.46). The difference between groups (0.78 nL/cm(2) (0.19-1.36)) was statistically significant (P = 0.010). The number of active follicles/cm(2) decreased by 0.86 (0.44-1.28) and 0.08 (-0.53 to 0.69), respectively (P = 0.029). The difference in qualitative scores between the groups (0.93 (0.08-1.78)) was statistically significant ( P = 0.032). Overall, 19.3% of the subjects reported an AE (18.1% in the DSG-OC group, 22.1% in the control group).

CONCLUSION

Novial effectively reduces seborrhea after only four cycles of treatment and may be a suitable oral contraceptive for women wishing to improve their facial skin condition.

Patient experiences with oily skin: the qualitative development of content for two new patient reported outcome questionnaires

Objective

To develop the content for two new patient reported outcome (PRO) measures to: a) assess the severity of symptoms; and b) the impact of facial skin oiliness on emotional wellbeing using qualitative data from face to face, and internet focus groups in Germany and the US.

Methods

Using input from initial treatment satisfaction focus groups (n = 42), a review of relevant literature and expert clinicians (n = 3), a discussion guide was developed to guide qualitative inquiry using Internet focus groups (IFGs). IFGs were conducted with German (n = 26) and US (n = 28) sufferers of oily skin. Questionnaire items were generated using coded transcript data from the focus groups. Cognitive debriefing was conducted online with 42 participants and face to face with an additional five participants to assess the comprehension of the items.

Results

There were equal numbers of male and female participants; mean age was 35.4 (SD 9.3) years. On average, participants had had oily skin for 15.2 years, and 74% (n = 40) reported having mild-moderate acne. Participants reported using visual, tactile and sensory (feel without touching their face) methods to evaluate the severity of facial oiliness. Oily facial skin had both an emotional and social impact, and was associated with feelings of unattractiveness, self-consciousness, embarrassment, irritation and frustration. Items were generated for a measure of oily skin severity (Oily Skin Self-Assessment Scale) and a measure of the impact of oily skin on emotional well-being (Oily Skin Impact Scale). Cognitive debriefing resulted in minor changes to the draft items and confirmed their face and content validity.

Conclusion

The research provides insight into the experience of having oily skin and illustrates significant difficulties associated with the condition. Item content was developed for early versions of two PRO measures of the symptoms and emotional impact of oily facial skin. The psychometric validation of these measures reported elsewhere.