New Treatments for Adult Female Acne

Adult female acne is a common dermatological condition whose management is challenging because of its tendency toward chronicity, recurrence, and resistance to available treatments. The aim of this systematic review is to study the effectiveness, safety, and use profile of antiandrogenic treatments used as an alternative in women who present alterations in androgen hormones or receptors or who have a state of hyperandrogenism.

A search was conducted in the PubMed database including all types of epidemiological studies-clinical trials, retrospective, prospective, cohort, and case-series studies-published in the last 10 years and performed in humans that evaluated the effectiveness and safety of antiandrogenic treatments-spironolactone, metformin, and bicalutamide-in patients with acne.

Thirteen articles met the inclusion criteria, evaluating a total of 1335 patients. Of these 13 articles, 4 (30.8%) addressed spironolactone and 9 (69.2%) addressed metformin. No studies were found evaluating the effectiveness and tolerability of bicalutamide for acne. Both drugs showed good results in reducing acne lesions, measured with different scales, and in terms of safety and tolerability. The most frequent adverse effects were menstrual irregularities in the case of spironolactone and gastrointestinal discomfort with the use of metformin. The latter also showed good results in improving the lipid profile, insulin resistance, and BMI, which should be taken into consideration in the management of acne associated with polycystic ovary syndrome.

Although antiandrogenic treatments such as spironolactone and metformin have shown promise as options for the management of acne in adult women, more controlled and randomized studies comparing these drugs with each other and with placebo are needed to evaluate their efficacy and tolerability with a higher level of evidence.