Efficacy and Safety of Hormonal Therapies for Acne: A Narrative Review

Acne vulgaris is a common inflammatory skin disease with a strong hormonal component, especially in women. Hormonal therapies are increasingly used in moderate-to-severe or treatment-resistant cases. This review aims to summarize current evidence on the efficacy and safety of hormonal treatments for acne.

A narrative review was conducted using PubMed, Scopus, and Web of Science, including studies published from 2010 to 2025. Eligible articles included randomized controlled trials, cohort studies, systematic reviews, and meta-analyses evaluating hormonal therapies such as combined oral contraceptives (COCs), spironolactone, cyproterone acetate, and topical antiandrogens (eg, clascoterone). Data were extracted on mechanisms of action, clinical efficacy, safety, and treatment indications to ensure consistent synthesis across therapies.

Spironolactone consistently reduced lesion counts and improved quality of life in adult women, with good tolerability and a low risk of hyperkalemia. COCs effectively decreased both inflammatory and non-inflammatory lesions, with similar efficacy across different progestins. Clascoterone, a topical antiandrogen, showed significant improvement in lesion counts with minimal systemic absorption. Preliminary evidence also supports the use of topical spironolactone. Compared with antibiotics, hormonal therapies provide durable disease control and avoid antimicrobial resistance.

Hormonal therapies are effective and well-tolerated options for acne, particularly in women with hormonal patterns or refractory disease. By specifically targeting androgen-driven pathways, hormonal agents offer sustained improvement and should be incorporated into personalized acne management.