Pharmacology of hormonal contraceptives and acne

Abstract

Higher free testosterone levels in women are a function of lower levels of sex hormone-binding globulins (SHBG), higher levels of total testosterone, or both. When free testosterone levels are decreased, sebum production, a pathogenic feature of acne vulgaris, is also decreased. Oral contraceptives (OCs) decrease free testosterone levels by reducing testosterone production by the ovaries and adrenal glands, increasing SHBG, and inhibiting conversion of free testosterone to dihydrotestosterone. Studies have shown that the progestin component of OCs lowers androgen levels, which are directly associated with the development of acne lesions. Currently, 3 OCs have received approval for acne from the US Food and Drug Administration. For patients with acne who are already benefiting from OC treatment, there is no need to change the OC; however, when an OC proves insufficient against sebum production, switching to a formulation that is approved for acne is recommended.