American Journal of Clinical Dermatology

, Volume 19, Issue 3, pp 449–455 | Cite as

The Use of Hormonal Antiandrogen Therapy in Female Patients with Acne: A 10-Year Retrospective Study

  • Joyce H. Park
  • Amanda Bienenfeld
  • Seth J. Orlow
  • Arielle R. Nagler
short communication



Little is known about how dermatologists prescribe hormonal antiandrogen acne treatment (HAAT).


The aim of this study was to investigate dermatologists’ HAAT-prescribing habits and HAAT’s impact on systemic antibiotic use in women with acne.


We performed a retrospective study at an academic medical center of female patients receiving HAAT (combined oral contraceptive [COC], spironolactone) for acne from January 2005 to October 2015. Data from a control group of female acne patients who never received HAAT were also collected.


A total of 672 female patients received HAAT. Out of all systemic medications for acne, antibiotics were used as first-line treatment in 39% of patients, COCs in 12%, and spironolactone in 21%. Mean antibiotic durations in patients who initiated HAAT for the first time at the study site (250.4 days) were significantly longer than in patients who received HAAT prior to presentation and continued HAAT at the study site (192.0 days) (p = 0.021). A statistically significant inverse association was found between HAAT use and mean antibiotic duration (p = 0.016).


HAAT is not typically used as a first-line systemic therapy in women with acne. HAAT usage is associated with shorter cumulative antibiotic durations and early HAAT initiation can decrease systemic antibiotic use in acne treatment.



We would like to acknowledge Dr Xiaochun Li and Dr Matthew Park for providing statistical and technical assistance in this research project.

Compliance with Ethical Standards


No funding was provided for conduct of the study and/or preparation of the paper. No funding organization or sponsor was involved in any aspect of the following: design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

Conflict of interest

In the past 12 months, Dr Seth Orlow has served as a consultant for Dermira, on the advising board for Unilever, and as a board member for Almirall. Dr Nagler, Dr Park, and Ms Bienenfeld have no conflicts of interest to declare.


  1. 1.
    Collier CN, Harper JC, Cafardi JA, Cantrell WC, Wang W, Foster KW, et al. The prevalence of acne in adults 20 years and older. J Am Acad Dermatol. 2008;58(1):56–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Dreno B. The changing faces of acne. Br J Dermatol. 2015;172(Suppl 1):1–2.CrossRefPubMedGoogle Scholar
  3. 3.
    Poli F, Dreno B, Verschoore M. An epidemiological study of acne in female adults: results of a survey conducted in France. J Eur Acad Dermatol Venereol JEADV. 2001;15(6):541–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Barros B, Thiboutot D. Hormonal therapies for acne. Clin Dermatol. 2017;35(2):168–72.CrossRefPubMedGoogle Scholar
  5. 5.
    Deplewski D, Rosenfield RL. Role of hormones in pilosebaceous unit development. Endocr Rev. 2000;21(4):363–92.CrossRefPubMedGoogle Scholar
  6. 6.
    Das S, Reynolds RV. Recent advances in acne pathogenesis: implications for therapy. Am J Clin Dermatol. 2014;15(6):479–88.CrossRefPubMedGoogle Scholar
  7. 7.
    Dreno B, Layton A, Zouboulis CC, Lopez-Estebaranz JL, Zalewska-Janowska A, Bagatin E, et al. Adult female acne: a new paradigm. J Eur Acad Dermatol Venereol JEADV. 2013;27(9):1063–70.CrossRefPubMedGoogle Scholar
  8. 8.
    Thiboutot D. Hormones and acne: pathophysiology, clinical evaluation, and therapies. Semin Cutan Med Surg. 2001;20(3):144–53.CrossRefPubMedGoogle Scholar
  9. 9.
    Thiboutot D. Acne: hormonal concepts and therapy. Clin Dermatol. 2004;22(5):419–28.CrossRefPubMedGoogle Scholar
  10. 10.
    Thiboutot DM. Endocrinological evaluation and hormonal therapy for women with difficult acne. J Eur Acad Dermatol Venereol JEADV. 2001;15(Suppl 3):57–61.CrossRefPubMedGoogle Scholar
  11. 11.
    Zaenglein AL, Pathy AL, Schlosser BJ, Alikhan A, Baldwin HE, Berson DS, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74(5):945e33–973e33.CrossRefGoogle Scholar
  12. 12.
    Arowojolu AO, Gallo MF, Lopez LM, Grimes DA. Combined oral contraceptive pills for treatment of acne. Cochrane Database Syst Rev. 2012;(6):CD004425.Google Scholar
  13. 13.
    Arrington EA, Patel NS, Gerancher K, Feldman SR. Combined oral contraceptives for the treatment of acne: a practical guide. Cutis. 2012;90(2):83–90.PubMedGoogle Scholar
  14. 14.
    Bettoli V, Zauli S, Virgili A. Is hormonal treatment still an option in acne today? Br J Dermatol. 2015;172(Suppl 1):37–46.CrossRefPubMedGoogle Scholar
  15. 15.
    Boisselle A, Dionne FT, Tremblay RR. Interaction of spironolactone with rat skin androgen receptor. Can J Biochem. 1979;57(7):1042–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Harper JC. Should dermatologists prescribe hormonal contraceptives for acne? Dermatol Ther. 2009;22(5):452–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Tan JK, Ediriweera C. Efficacy and safety of combined ethinyl estradiol/drospirenone oral contraceptives in the treatment of acne. Int J Womens Health. 2010;1:213–21.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Koo EB, Petersen TD, Kimball AB. Meta-analysis comparing efficacy of antibiotics versus oral contraceptives in acne vulgaris. J Am Acad Dermatol. 2014;71(3):450–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Goodfellow A, Alaghband-Zadeh J, Carter G, Cream JJ, Holland S, Scully J, et al. Oral spironolactone improves acne vulgaris and reduces sebum excretion. Br J Dermatol. 1984;111(2):209–14.CrossRefPubMedGoogle Scholar
  20. 20.
    Muhlemann MF, Carter GD, Cream JJ, Wise P. Oral spironolactone: an effective treatment for acne vulgaris in women. Br J Dermatol. 1986;115(2):227–32.CrossRefPubMedGoogle Scholar
  21. 21.
    Brown J, Farquhar C, Lee O, Toomath R, Jepson RG. Spironolactone versus placebo or in combination with steroids for hirsutism and/or acne. Cochrane Database Syst Rev. 2009;15(2):CD000194.Google Scholar
  22. 22.
    Layton AM, Eady EA, Whitehouse H, Del Rosso JQ, Fedorowicz Z, van Zuuren EJ. Oral spironolactone for acne vulgaris in adult females: a hybrid systematic review. Am J Clin Dermatol. 2017;2:169–91.CrossRefGoogle Scholar
  23. 23.
    Gollnick HP, Bettoli V, Lambert J, Araviiskaia E, Binic I, Dessinioti C, et al. A consensus-based practical and daily guide for the treatment of acne patients. J Eur Acad Dermatol Venereol JEADV. 2016;30(9):1480–90.CrossRefPubMedGoogle Scholar
  24. 24.
    Nast A, Dreno B, Bettoli V, Bukvic Mokos Z, Degitz K, Dressler C, et al. European evidence-based (S3) guideline for the treatment of acne-update 2016-short version. J Eur Acad Dermatol Venereol JEADV. 2016;30(8):1261–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Barbieri JS, James WD, Margolis DJ. Trends in prescribing behavior of systemic agents used in the treatment of acne among dermatologists and nondermatologists: a retrospective analysis, 2004–2013. J Am Acad Dermatol. 2017;77(3):456e4–463e4.CrossRefGoogle Scholar
  26. 26.
    Thiboutot DM, Dreno B, Abanmi A, Alexis AF, Araviiskaia E, Barona Cabal MI, et al. Practical management of acne for clinicians: an international consensus from the Global Alliance to Improve Outcomes in Acne. J Am Acad Dermatol. 2017;78(2S1):S1–23.e1.PubMedGoogle Scholar
  27. 27.
    Neuhaus CP, Nagler AR, Orlow SJ. Teens, acne, and oral contraceptive pills: the need for greater clarity on when teens can consent. JAMA Dermatol. 2017;153(4):249–50.CrossRefPubMedGoogle Scholar
  28. 28.
    George R, Clarke S, Thiboutot D. Hormonal therapy for acne. Semin Cutan Med Surg. 2008;27(3):188–96.CrossRefPubMedGoogle Scholar
  29. 29.
    Gollnick H, Cunliffe W, Berson D, Dreno B, Finlay A, Leyden JJ, et al. Management of acne: a report from a global alliance to improve outcomes in acne. J Am Acad Dermatol. 2003;49(1 Suppl):S1–37.CrossRefPubMedGoogle Scholar
  30. 30.
    Nast A, Dreno B, Bettoli V, Degitz K, Erdmann R, Finlay AY, et al. European evidence-based (S3) guidelines for the treatment of acne. J Eur Acad Dermatol Venereol JEADV. 2012;26(Suppl 1):1–29.CrossRefPubMedGoogle Scholar
  31. 31.
    Dreno B, Bettoli V, Ochsendorf F, Layton A, Mobacken H, Degreef H, et al. European recommendations on the use of oral antibiotics for acne. Eur J Dermatol. 2004;14(6):391–9.PubMedGoogle Scholar
  32. 32.
    Dreno B, Thiboutot D, Gollnick H, Bettoli V, Kang S, Leyden JJ, et al. Antibiotic stewardship in dermatology: limiting antibiotic use in acne. Eur J Dermatol. 2014;24(3):330–4.PubMedGoogle Scholar
  33. 33.
    Thiboutot D, Gollnick H, Bettoli V, Dreno B, Kang S, Leyden JJ, et al. New insights into the management of acne: an update from the global alliance to improve outcomes in acne group. J Am Acad Dermatol. 2009;60(5 Suppl):S1–50.CrossRefPubMedGoogle Scholar
  34. 34.
    Lee YH, Liu G, Thiboutot DM, Leslie DL, Kirby JS. A retrospective analysis of the duration of oral antibiotic therapy for the treatment of acne among adolescents: investigating practice gaps and potential cost-savings. J Am Acad Dermatol. 2014;71(1):70–6.CrossRefPubMedGoogle Scholar
  35. 35.
    Nagler AR, Milam EC, Orlow SJ. The use of oral antibiotics before isotretinoin therapy in patients with acne. J Am Acad Dermatol. 2016;74(2):273–9.CrossRefPubMedGoogle Scholar

Copyright information

© This is a U.S. government work and its text is not subject to copyright protection in the United States; however, its text may be subject to foreign copyright protection 2018

Authors and Affiliations

  • Joyce H. Park
    • 1
  • Amanda Bienenfeld
    • 2
  • Seth J. Orlow
    • 1
  • Arielle R. Nagler
    • 1
  1. 1.The Ronald O. Perelman Department of DermatologyNew York University Langone HealthNew YorkUSA
  2. 2.New York University School of MedicineNew YorkUSA

Personalised recommendations