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Review
. 2025 Jan;15(1):45-59.
doi: 10.1007/s13555-024-01324-8. Epub 2025 Jan 3.

Hormonal Therapies for Acne: A Comprehensive Update for Dermatologists

Courtney A Smith #  1 , Emily Gosnell #  1 , Turkan Banu Karatas  1 , Chelsea Deitelzweig  1 , Elizabeth M B Collins  2 , Howa Yeung  3   4
Affiliations
Review

Hormonal Therapies for Acne: A Comprehensive Update for Dermatologists

Courtney A Smith et al. Dermatol Ther (Heidelb). 2025 Jan.

Abstract

Introduction: Acne impairs quality of life, often leads to permanent scars, and causes psychological distress. This review aims to update dermatologists on the Federal Drug Administration (FDA)-approved and off-label use of combined oral contraceptives (COC), clascoterone, spironolactone, and emerging hormonal therapies for acne treatment.

Methods: We reviewed current literature on hormonal acne treatments and discussed common patient concerns, barriers to care, and individualized care needs.

Results: Different brands and dosings of COC have generally similar efficacy in treating acne. Dermatologists should discuss contraceptive options and provide individualized shared decision-making with patients based on patient preferences, contraceptive needs, comorbidity profile, access, and cost. Spironolactone is an effective acne treatment with clinical trial data to support its use as a first-line acne treatment for women with acne. Potassium monitoring is of low value for patients on spironolactone unless patients have specific risk factors for hyperkalemia. Clascoterone is a safe and effective topical anti-androgen for the treatment of acne in men and women with limited systemic effects on reproductive hormones.

Conclusion: Hormonal therapies are essential strategies to treat acne. Clinicians should expand the use of existing and emerging hormone therapy as part of their acne treatment strategies.

Keywords: Acne vulgaris; Androgens; Hormonal therapies; Pathogenesis.

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Conflict of interest statement

Declarations. Conflict of Interest: Dr. Howa Yeung reports receiving grant funding from the American Acne and Rosacea Society, Dermatology Foundation, and the Department of Veterans Affairs unrelated to the submitted work, honorarium from the American Academy of Dermatology, and has served on the advisory boards of Sanofi-Genzyme, and L'Oréal Dermatological Beauty. Courtney A. Smith, Emily Gosnell, Turkan Banu Karatas, Chelsea Deitelzweig, and Dr. Elizabeth Collins have no conflicts to declare. Ethical Approval: This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.

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