Acne and Rosacea Charity Training Manual

Hormonal therapy in women
In women with severe acne, not responding to conventional antibiotics with a topical retinoid, hormonal therapy may be indicated. This may be due to
polycystic ovarian syndrome where women produce excess free testosterone which may lead to severe and or persistent acne.
Dianette
Dianette is licensed for the treatment of acne but is also an effective oral contraceptive agent. The oestrogen, ethyl-oestradiol will increase sex hormone
binding globulin which will bind to and inactivate testosterone. The progesterone, cyproterone acetate, inhibits 5-reductase and inhibits the activation
of testosterone to di-hydro-testosterone in the sebaceous gland. It is successful in treating acne in about 40% of women but due to increased risk of
thromboembolic phenomenon, should be used only short term i.e. 6 months. It has a number of side effects and is not well tolerated by some women.
In practice, Dianette is poorly used and is often given as a contraceptive agent in women who have acne of any severity and often continued for years. A
major problem is that acne will often flare significantly 2-3 months after the drug is stopped.
Yasmin
Yasmin is marketed as an oral contraceptive but is often given to women who have acne. The oestrogen is the same as Dianette but the progesterone is
drospirenone, an analogue of spironolactone, which amongst other anti-androgenic effects, inhibits 5-reductase. In practice, it is not as effective in
treating acne as Dianette and may have the same problem of rebound of acne after treatment is stopped.