ACNE IN AN ADULT WOMAN

Why talk specifically about acne in women?

• Acne is much more common in young women than in young men.
• A woman's hormonal cycle affects her acne.
• Hormonal approaches (e.g. spironolactone) can be helpful in women.
• A woman's birth control method can affect her acne.
• A woman can become pregnant, and she may breastfeed.

Does adult female acne differ from teenage acne?

Yes. The adult woman with acne tends to have primarily inflammatory lesions (pimples) and few visible comedones (blackheads and whiteheads). The distribution is typically along the jawline and chin (as opposed to the teenage pattern of acne uniformly distributed on the face).

What are signs of hyperandrogenism in a woman?

• Menstrual disturbances
• Impaired fertility
• Hirsutism (excessive, dark hair growth in typically male areas)
• PCOS (polycystic ovary syndrome)

Hyperandrogenism can aggravate acne. Full hormonal workup should be considered in patient who shows signs of hyperandrogenism.

What birth control measures can aggravate acne?

• Progestin only mini-pills, e.g. Camila, Errin, Heather, Incassia, Jencycla, and Nora-Be.
• Depo-Provera injections
• Subdermal implants, e.g. Nexplanon
• Hormonal IUDs, e.g. Mirena, Skyla. 
  

Some progestins are chemically similar to testosterone and can increase androgen activity, leading to increased oil production, which can contribute to acne.  For example, a woman is 2.5 times more likely to develop acne if she receives a hormonal IUD as compared to a Copper IUD.

What birth control measures can improve acne?

• The estrogen in combined birth control pills (containing both estrogen and progestin) helps to lower androgen levels in the body, which can reduce oil production and improve acne. Examples of combined birth control pills that can help with acne include Yaz, Yasmin, Alesse, and others. 
• BCPs that contain drospirenone.

What BCPs contain drospirenone?

Drospirenone has anti-androgenic properties and can block the effects of androgens, reducing acne lesions, inflammation, and oil production. BCPs that contain drospirenone include:

• Yaz and Yasmin: These are combination birth control pills containing drospirenone, a progestin, and ethinyl estradiol, an estrogen.
• Beyaz: This BCP also contains drospirenone and ethinyl estradiol, but it also includes levomefolate calcium, a folic acid supplement.
• Slynd: This is a progestin-only contraceptive pill (POP) containing drospirenone.
• Other brands: Gianvi, Jasmiel, and Nikki

What BCPs are FDA-approved for acne?

• Yaz is a brand-name drug that contains the active drugs drospirenone and ethinyl estradiol. This active drug combination is also available as a generic medication.
• Estrostep Fe contains 2 hormones: norethindrone (a progestin) and ethinyl estradiol (an estrogen). There is a small amount of iron (ferrous fumarate) in each of the 7 inactive tablets taken during the fourth week. The inactive pills do not contain any hormones.
• Ortho Tri-Cyclen contains norgestimate and ethinyl estradiol

Even though a BCP is not FDA-approved for acne, it may still be beneficial for reasons noted above. It just may be that the drug company did not go through the formal process to get FDA approval.