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 After six months, both treatments reduced acne by just over 50
percent, prompting dermatologists to call the Pill a good
alternative for some women and a means of avoiding the drawbacks of
stronger oral acne medications or long-term antibiotic use.
Past research has shown that both antibiotics and birth control
pills can improve acne, but the new review compared the two options
side-by-side and found antibiotics worked better after three months,
but after six months of use, results were about equal.
“Oral contraceptives (OCPs) take longer to work because they have a
different mechanism of action,” said Dr. Kelly H. Tyler, who was not
involved in the new review.
“Antibiotics have anti-inflammatory properties, and OCPs do not have
those same properties, so the reduction in acne is going to be more
gradual and less dramatic in the beginning,” said Tyler, a
dermatologist at Ohio State University in Columbus.
Antibiotics help to reduce inflammation of existing acne, whereas
oral contraceptives reduce free or circulating androgens, lowering
production of the oily sebum that plugs pores, which lowers the risk
of new acne developing, she told Reuters Health by email.
The review included 32 randomized controlled trials of antibiotics
or oral contraceptives for treating acne. In general, after three
months of treatment, antibiotics had reduced the number of
whiteheads or cysts by 48 percent, compared to 37 percent with oral
contraceptives.
But by six months, oral contraceptives had caught up, reducing acne
by 55 percent, compared to 53 percent with antibiotics, according to
the results published in the Journal of the American Academy of
Dermatology.
The authors caution that the antibiotics trials they analyzed
included both men and women, which interferes with the comparison to
the contraceptive trial results because hormones do play such an
important role in acne.
Nonetheless, they write, the findings suggest birth control pills
“may have a more important first-line preventive role in chronic
acne than previously accepted.”
Dr. Steven R. Feldman, a dermatologist at Wake Forest University
School of Medicine in Winston-Salem, North Carolina, agreed. “This
confirms that birth control pills are a good solid treatment for
acne, and they’re probably underutilized,” he told Reuters Health.
The Food and Drug Administration has approved many birth control
medications for treating acne as well as preventing pregnancy, so
there should be no barrier to prescribing them, but dermatologists
may still be reluctant, said Feldman, who was not involved in the
new study.
Dermatologists often recommend low-dose hormonal birth control as an
option for female patients, but don’t actually write a prescription
for it, he told Reuters Health. Then the patient returns to her
primary care doctor, who may write the prescription, and when the
acne clears up the patient does not return to the dermatologist.
If the hormonal option does not work, the patient does return to the
dermatologist, which gives dermatologists a biased impression of how
effective the drugs are, he said.
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“Given the desire to minimize antibiotic resistance and exposure,
hormonal birth control could be a good alternative,” Feldman said.
Both antibiotics and birth control can interfere with other
medications, and both options have side effects, said Dr. Robert
Dellavalle, chief of the dermatology service at the Denver VA
Medical Center.
“Severe allergic reactions are very rare but more common with
antibiotics,” he told Reuters Health by email. “Blood clots are more
common with oral contraceptives.”
According to the review, oral contraceptives are more effective than
he had previously assumed, said Dellavalle, who was not involved in
the study.
Even if a woman’s employer refuses to reimburse for birth control,
they would be required to reimburse for the same hormonal medication
prescribed for acne rather than for preventing pregnancy, Feldman
said.
“They may or may not cover birth control, but they do cover
treatment for acne,” he said. “There should be no issue.”
“Even if you got a denial from your insurer, probably a quick appeal
letter might well get that corrected,” he said.
For women with severe acne, a combination of hormonal birth control
and antibiotics may lessen symptoms and remove the need for
Isotretinoin, a much stronger oral acne medicine that carries a
serious risk of birth defects, Feldman said.
Women using Isotretinoin are required to avoid pregnancy because the
drug has been shown to be teratogenic, meaning it causes serious
abnormalities in a developing fetus.
Feldman said he does not prescribe medications that are so “horribly
teratogenic” to women of childbearing age if there is another option
that may work. He prescribes hormonal birth control first, to see if
it will help clear up the skin and prevent pregnancy in the coming
weeks and months. Only if acne is a persistent problem, then he may
prescribe the stronger medication as well.
Men do not have to worry about potential birth defects, Feldman
noted. “For severe acne in men with scarring, you might even go to
Isotretinoin first.”
SOURCE: http://bit.ly/UcLxTh
Journal of the American Academy of Dermatology, online May 28, 2014.
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