Hormonal Therapies in the Management of Acne Vulgaris

June 2022 | Volume 21 | Issue 6 | 618 | Copyright © June 2022


Published online May 31, 2022

doi:10.36849/JDD.6494

Gaurav Dash MDa, Anant Patil MDb, George Kroumpouzos MDc,d,e, Hassan Galadari MDf, Michael H. Gold MDg, Stephan Grabbe MDh, Mohamad Goldust MDI

aDepartment of Dermatology and Venereology, Hitech Medical College and Hospital, Bhubaneswar, India
bDepartment of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India
cDepartment of Dermatology, Alpert Medical School of Brown University, Providence, RI
dDepartment of Dermatology, Medical School of Jundiaí, São Paulo, Brazil
eGK Dermatology, PC, South Weymouth, MA
fCollege of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
gGold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN
hDepartment of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
iDepartment of Dermatology, University Medical Center Mainz, Mainz, Germany

Abstract
Acne vulgaris is a multifactorial chronic disorder of the pilosebaceous unit. Established treatments include topical retinoids, antibiotics in mild cases, and oral antibiotics and isotretinoin in moderate to severe cases. Anti-androgens and other hormonal therapies constitute another group of drugs in the armamentarium of acne management. These can be used in patients who do not respond to the aforementioned treatments or when other systemic drugs cannot be tolerated. Recent approval of topical androgen receptor blocker is an additional armamentarium for the management of acne. Considering limited systemic exposure and good efficacy, it has potential for wide usage in patients with acne. In this article, we critically review currently available hormonal treatment options based on published literature search of an electronic database (MEDLINE/PubMed) performed through June 2021.

J Drugs Dermatol. 2022;21(6):618-623. doi:10.36849/JDD.6494

INTRODUCTION

Acne vulgaris (AV) is a common disorder that mostly affects the young population, ie, adolescents with around 80-90 % prevalence which usually subsides by 30 years of age. However, it may persist longer in some cases. A study by Perkins et al involving 2895 women reported that acne peaked in teenage years and in some cases extended through the fifth decade (adult acne).1 In approximately 40-50% of the patients, AV may continue into adulthood, known as persistent adult acne instead of remitting within the third decade of life.2 There is also a group of patients that develop the first episode of acne after 25 years of age. This is known as late onset adult acne/acne tarda.3-5 AV severely impacts the quality of life of the affected individuals due to severity as well as easy visibility of the skin lesions. Also, it has a negative psychological impact with increasing incidences of social embarrassment, anxiety, and depression. Open or closed comedones, papules, pustules with associated seborrhoea are the most common manifestations of AV. In severe cases, nodules and cysts followed by scarring are observed. Conventional treatment modalities consist of topical therapies and oral medications. Topical therapies such as antibiotics and retinoids are currently recommended for mild acne whereas oral antibiotics and oral retinoids are used for the treatment of patients with moderate to severe AV.6 Some patients of acne have unpredictable course. Patients may have recurrent episodes of AV resistant to conventional therapy or due to hyperandrogenism.7-9 These patients can have benefit from hormonal therapy. Moreover, with wider acceptance of acne as an inflammatory condition, there is a wider acceptance of non-antibiotic options for the treatment of AV. In this article, we discuss the role of hormonal therapies in treatment of AV.

MATERIALS AND METHODS

We performed a literature search using the electronic database MEDLINE/PUBMED through June 2021. The search terms "anti-androgens", "acne", "hormonal acne", "adult acne", "adolescent acne", "hormonal therapy", "spironolactone", "oral contraceptive pills", "cyproterone acetate" were used to retrieve the articles from the database. Articles published in English language in peer review journals were used for qualitative analysis.

Role of Androgen in the Pathogenesis of AV
AV is an abnormality of the pilosebaceous unit (PSU) with multifactorial etiology. An androgen-mediated process plays a key role in the pathogenesis of acne.10 Androgens are mainly