MIAMI BEACH – Acne flares on the chin can usually be managed in women with oral contraceptive therapy and spironolactone, according to Dr. Diane Berson.
These acne breakouts may be just a few pimples and are often related to the menstrual cycle, Dr. Berson of Cornell University and New York Presbyterian Hospital, both in New York, said at the South Beach Symposium.
“We know that women do develop premenstrual acne,” she said, citing a 2014 survey in which 65% of 105 respondents reported worsening of acne with their menstrual cycles, and 56% of those women reported acne in the week preceding menses (J. Clin. Aesthet. Dermatol. 2014;7:30-4).
Stress also seems to play a role, with another recent study showing that various stress factors including noise, socioeconomic pressures, light stimuli, and sleep deprivation also contribute to acne breakouts – again, often on the chin, she noted.
Oral contraceptives decrease testosterone, thereby reducing sebum production and, hopefully, acne breakouts, she said. With the traditional 21-day active/7-day inactive oral contraceptives, women tend to have acne flares during the 7-day inactive part of the treatment cycle, so increasing the active treatment cycle to 24 days of active therapy and 4 days of “blanks” can limit premenstrual syndrome and acne breakouts.
Contraceptive patches and rings provide a more continuous release of estrogen, so these products may also be helpful for women with hormonally induced acne, she added.
“Spironolactone is a great adjunct,” she said, noting that “it is inexpensive, really has minimal side effects, and women notice they get fewer hormonal breakouts when they are on it.”
A dose of 25-50 mg of spironolactone is usually sufficient, she said. “I have gone up to 100 mg, but my average patient is on 50 mg.” Patients also taking a drospirenone-containing oral contraceptive such as Yaz or Yasmin, get 25 mg of spironolactone, because they are already getting the equivalent of 25 mg in the oral contraceptive.
In another study, adding spironolactone to topical retinoid treatment led to a superior response to retinoids alone in the treatment of female adult cyclical acne (J. Drugs Dermatol. 2014;13:126-9), she noted.
“For our women patients with acne, a big part of our management is maintenance therapy,” she concluded. With hormonal flares, “I find that the best maintenance is a topical retinoid paired with either an oral contraceptive pill or spironolactone. That way you are giving them a topical comedolytic to decrease their clogging, and the hormonal treatment to decrease their hormonally induced flares.”
Dr. Berson is a consultant for Allergan, Galderma, Kythera Biopharmaceuticals, La Roche-Posay, Procter & Gamble, and Valeant Pharmaceuticals International.