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Birth Control For Acne
For women, acne, especially severe acne, can lead to embarrassment, anxiety, social isolation, and permanent skin scarring. Severe acne can even lower the chances of employment in some industries.
Dermatologists have been using birth control pills to treat acne in women for decades. However, only three pills have actually been approved by the FDA for treating acne.
In general, birth control to treat acne is often advised for healthy women who also need contraception. It is typically started after other acne treatments, such as topical creams and oral antibiotics, have failed to clear up the skin. Here is information about the risks and benefits of taking birth control pills for acne. It can help you make an informed decision about what's right for you.
As every teenager knows, there's a clear relationship between hormones and acne. Some women experience premenstrual flare-ups of acne as their hormone levels shift during their cycle. And for some, acne simply persists through the years, even after menopause.
Acne is triggered by an excess production of sebum. Sebum is an oil made by glands in your skin. Along with skin cells, sebum can clog pores and promote the growth of bacteria that contribute to acne. Androgens, a group of hormones that includes testosterone, stimulate your skin to produce sebum.
A woman's ovaries and adrenal glands normally produce a low level of androgens. Higher levels of androgens can lead to excess sebum. Taking birth control pills that contain both estrogen and progesterone lowers the amount of androgens in your body. This results in less sebum and less severe acne.
The last decade has seen an explosion in new types of birth control. But so far, only three types of birth control pills have been approved by the FDA for treating acne. All three are "combination" oral contraceptives that contain both estrogen and progesterone. In fact, birth control pills that contain only progesterone can actually make acne worse.
Each type of birth control pill used for acne contains a low dose of the same form of estrogen. But each one uses a different form of progesterone.
The FDA has approved the following types of birth control for acne:
Studies have not shown a major difference among these three pills in terms of how well they treat acne.
These three oral contraceptives have been approved for treating moderate acne in women who:
In actual practice, doctors prescribe birth control for the full spectrum of acne, from mild to severe.
In addition, doctors may prescribe additional birth control products for acne. For example, the oral contraceptives Yasmin and Alesse have both been clinically shown to improve acne. But neither one has been approved by the FDA for this use.
If you're already taking an oral contraceptive that's working well in treating acne, there's no need to switch brands. But if you are taking birth control pills for acne for the first time, it's best to use one of the three types now approved for acne treatment.
You may need to take an oral contraceptive for a few months before your skin starts to clear. And an initial flare-up of acne is common when a woman first starts taking birth control pills.
Birth control pills work on only one acne-related factor -- excess sebum. Doctors often prescribe other forms of acne treatment -- topical medications or antibiotics -- to be used alongside them for best results in clearing the skin.
If you have severe acne along with irregular periods, excess facial hair, or obesity, your doctor may do further testing for a medical condition called polycystic ovary syndrome or other hormonal condition.
Several clinical trials have shown that taking combination birth control pills can result in:
Many women with severe acne take oral contraceptives with other acne treatments. For women who also want contraception, taking birth control pills for acne also offers one of the most reliable forms of contraception, as long as the pills are taken on schedule as prescribed.
Today's birth control pills contain lower doses of estrogen and progesterone than in the past. This has significantly lowered their medical risks. Still, women taking oral contraceptives do have a higher risk of side effects, including heart attack, stroke, and dangerous blood clots in the legs or lungs.
Other risks include:
A decision to take birth control pills needs to take into account your medical history. Certain medical conditions could become worse if you use an oral contraceptive. Birth control pills are usually not advised if you have any of the following conditions:
You also shouldn't take oral contraceptives if:
Here are tips for getting the most benefit from your acne treatment:
Acne That Won't Go Away: Here Are The Reasons Why Those Acne-reducing Creams Aren't Working
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Ask The Doctor: My Son's Acne Is Affecting His Confidence But No Skincare Treatments Help
Dr Grant replies: Acne vulgaris (the full medical term for acne) often begins in the pre-adolescent child (age seven to 12 years old) and typically resolves in the third decade. Peak incidence in females is between age 13-16 years and in males is between age 15-18 years.
Acne is an inflammatory disorder of the pilosebaceous unit — comprised of the hair follicle and sebaceous gland — leading to inflammatory papules, pustules and nodules which can be painful.
The non-inflamed type of acne results in comedones known as blackheads and whiteheads. The typical distribution corresponds with areas of the body with large, hormonally responsive sebaceous glands such as the face, neck, chest, upper back and upper arms.
The majority of patients presenting for medical treatment have a mixture of both inflamed and non-inflamed acne.
Acne's development involves a complex interplay of hormonal stimulation of sebaceous glands; imbalance within the microbiome of the pilosebaceous follicle; and immune responses. Acne is also influenced by genetic factors (a strong family history), environment (how you treat your skin and the stress it is exposed to) and hormonal factors.
Mild acne is almost a rite of passage but patients with first-degree relatives who suffered moderate-to-severe acne have an increased risk of the disorder.
Common topical agents used to treat mild acne include benzoyl peroxide or salicylic acid cream/gel. They have antiseptic and anti-inflammatory properties, which help reduce the number of whiteheads, blackheads and bacteria on the surface of the skin.
A prescription is needed for topical retinoids such as tretinoin and adapalene. These come in gel/cream formulations and work by exfoliating dead cells from the surface of the skin, thereby preventing a build-up within the hair follicles.
Go for gentle face cleansers to avoid aggravating inflamed acne. It is recommended to double cleanse at night to remove oil, dirt, pollutants and SPF/makeup
Benzoyl peroxide, salicylic acid, azelaic acid and topical retinoids should be applied sparingly to the areas affected by acne, 20 minutes after washing your face.
All these acne products can make your face more sensitive to sunlight, so SPF 30+ should be worn during the daytime.
Most people need six to eight weeks of treatment to clear their acne. Treatment may need to continue less frequently to prevent recurrence. Go for gentle face cleansers to avoid aggravating inflamed acne. It is recommended to double cleanse at night to remove oil, dirt, pollutants and SPF/makeup.
The next step-up in treatment usually involves adding topical antibiotic lotion/gel, which helps kill the bacteria on the skin that can infect plugged hair follicles. Generally, six weeks of topical treatment is recommended. Then treatment is usually stopped, as there's a risk that the bacteria on your face could become resistant to antibiotics, potentially making your acne worse. For this reason, topical antibiotics are combined with other products like benzoyl peroxide or topical retinoids, providing dual action and making them more effective.
If moderate or severe acne develops, a further step-up to oral antibiotic medication is typically needed in combination with topical treatments. You should not combine topical and oral antibiotic treatments, though it is safe to continue other agents like benzyl peroxide.
The tetracycline class of antibiotics is considered first-line therapy. Topical retinoid is recommended for long-term maintenance therapy. Treatment is reviewed at three months and if no significant improvement is seen, referral to dermatology for stronger medication known as isotretinoin (Roaccutane) is advised.
If a patient begins to suffer with scarring, you should seek an urgent referral to dermatology so medication can be commenced to prevent long-term scarring.
Dr Jennifer Grant is a GP with Beacon HealthCheck
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