15 May

Many  oral  contraceptives have  been  studied in  the  treatment of acne  (Table  3). These  include those  containing ethinyl estradiol in  combination with  cyproter- one acetate  (Diane,  Dianette), ethynodiol diacetate (Demulen), levonorgestrel (TriPhasil,  Alesse),   norgestimate  (Ortho   Tri-Cyclenw),  desogesterel  (Desogen), and   drosperinone  (Yasmin,   Yaz).  Numerous  studies  point   to  the   efficacy   of ethinyl estradiol/cyproterone  acetate  oral  contraceptives (Diane  and  Dianette) in the  treatment of acne.  Reductions in  inflammatory lesion  count  on  the  order of

50% to  75% have  been  reported (44,45). Two  large  studies involving a  total  of approximately  500  women  with   moderate  acne  were   conducted  with   ethinyl estradiol 35 mg/norgestimate (Ortho  Tri-Cyclen). Improvement  in  inflammatory lesions,  total lesions,  and  global  assessment was noted with  this oral contraceptive after  six months of treatment (46,47). There  was  a 50% to  60% improvement in inflammatory lesions.  Decreases in serum free testosterone and  an increase in sex hormone-binding globulin were  noted  in the  active  group. Two large,  six-month, placebo-controlled  trials   (350  and   371  women,  respectively)  were   conducted

FIGURE 2    (See color insert.)  Adult female with acne of the lower face.

using   ethinyl  estradiol  20 mg/levonorgestrel  (Alesse)  in  the  treatment of  acne (48,49). In  each  study, the  oral  contraceptive demonstrated significantly greater reduction in acne lesion counts  and improvement in global assessment scores com- pared with placebo. The reduction in inflammatory lesion count was on the order of

47%. A study of 128 women with  mild-to-moderate acne compared the efficacy of ethinyl estradiol 30 mg/drospirenone (Yasmin)  and  ethinyl estradiol 35 mg/cypro- terone  acetate  (Diane-35)  in the  treatment of acne  for nine  cycles (50). Both treat- ments    produced   comparable  reductions   in   acne    lesion    counts,    with    an approximate 60% reduction in  inflammatory lesion  count.  Both  treatments also reduced sebum production and  yielded comparable increases in  sex  hormone- binding globulin. Two large placebo-controlled studies involving a total of approxi- mately   593  women with   moderate acne,  found improvement in  inflammatory lesions,  total  lesions,  global  assessment, and  quality of life in women who  were treated for six months with  a triphasic oral  contraceptive that  contains doses  of

20 to 35 mg of ethinyl estradiol in combination with  1.0 mg norethindrone acetate (Estrostep) (51). In  these  studies, inflammatory lesion  counts were  reduced by approximately 47% (51).

Oral contraceptives that  have  been approved for the treatment of acne in the United  States  include  ethinyl  estradiol  35 mg/norgestimate  (Ortho   Tri-Cyclen) ethinyl estradiol 20 to 35 mg/norethindrone acetate  (Estrostep), and  ethinyl estra- diol 20 mg/drospirenone (Yaz).

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