Hormonal therapy for acne: why not as first line therapy? facts and controversies.
Standard systemic therapeutic agents used in acne include oral antimicrobials, isotretinoin, and hormonal agents. Appropriate patient selection is the key to decide when to use hormonal agents as first-line therapy as well as to achieve optimal results. Indications of hormonal therapy in acne in girls and women include proven ovarian or adrenal hyperandrogenism, recalcitrant acne, acne not responding to repeated courses of oral isotretinoin, acne tarda, polycystic ovary syndrome, or the presence of clinical signs of hyperandrogenism such as androgenic alopecia or the presence of the seborrhea, acne, hirsutism, alopecia syndrome. We describe the hormonal agents currently available for acne treatment, discuss their indications and contraindications, and address the question of whether they may be used as a first-line therapy in acne.
Katsambas
Andreas D
AD
Department of Dermatology, University of Athens, Andreas Sygros Hospital, 5 Ionos Dragoumi Street, Kaisariani, Athens, 16121, Greece. katsabas@internet.gr
Dessinioti
Clio
C
D000152:Acne Vulgaris / Q000150:complications / Q000188:drug therapy*; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000726:Androgen Antagonists / Q000627:therapeutic use*; D002927:Cimetidine / Q000627:therapeutic use; D003278:Contraceptives, Oral, Hormonal / Q000627:therapeutic use; D017373:Cyproterone Acetate / Q000627:therapeutic use; D003879:Dermatologic Agents / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005485:Flutamide / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use; D007987:Gonadotropin-Releasing Hormone / Q000627:therapeutic use*; D006628:Hirsutism / Q000150:complications / Q000188:drug therapy; D006801:Humans; D015474:Isotretinoin / Q000627:therapeutic use; D007654:Ketoconazole / Q000627:therapeutic use; D008297:Male; D011085:Polycystic Ovary Syndrome / Q000150:complications / Q000188:drug therapy; D013148:Spironolactone / Q000627:therapeutic use
D000305:Adrenal Cortex Hormones; D000726:Androgen Antagonists; D003278:Contraceptives, Oral, Hormonal; D003879:Dermatologic Agents; D005938:Glucocorticoids; D013148:Spironolactone; D007987:Gonadotropin-Releasing Hormone; D017373:Cyproterone Acetate; D005485:Flutamide; D002927:Cimetidine; D015474:Isotretinoin; D007654:Ketoconazole