Treatment of acne with oral contraceptives: criteria for pill selection

Combination oral contraceptives (OCs) (those that contain estrogen and progestin) are widely used in the treatment of acne because they modify an excessively androgenic hormonal environment and can decrease lesions. Dermatologists' knowledge of the most appropriate OC may be hampered by an incomplete understanding of these agents, misleading promotion, and confusion surrounding the new generation of OCs. Despite reports attributing significance to the degree of androgenicity of the progestin components of OCs, in vitro and animal bioassays of androgenicity have little clinical relevance. Because all of today's low-dose combination OCs are estrogen dominant, they are equally beneficial in women with androgenic conditions such as acne. Use of the OC containing the lowest dose of each hormone, consistent with the patient's needs, can enhance compliance by preventing or limiting common early-cycle side effects (e.g., nausea/vomiting, breast tenderness, weight gain, headache), while providing acne improvement.