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Hormonal Therapy in Acne

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In females with resistant acne ie acne not responding to conventional therapy, we must always evaluate for any underlying hormonal imbalance. There are certain conditions like polycystic ovarian disease, SAHA syndrome, HAIRAN syndrome etc, where oral retinoids is not enough. There is a requirement of hormonal therapy. Hormonal therapy when combined with conventional treatment of acne shows good results.  The main aim of hormonal therapy is to counteract the effects of androgen on the sebaceous glands and hair follicles.

This is indicated in females who have acne which is resistant to conventional therapy. Adult onset acne, severe acne and recurrence soon after stoppage of therapy in female patients are indications for hormonal therapy.

  • Estrogen plus cypropterone acetate is the most popular combination used. It reduces sebum secretion by 68 %. It comes in a strip of 21 tablets. It can be strated at day 5 of menstrual cycle. The dose is one tablet a day which is best taken after dinner. Duration depends upon the requirement and severeity of acne. It is a safe and well tolerated therapy. acts by increasing a protein (sex hormone binding globulin) which binds with testosterone and decreases the circulating levels. This in turn reduces sebum production.

  • Spironolactone reduces sebum production and thus improves acne. It is a cost effective and well tolerated therapy.