title: A randomized comparative trial of a combined oral contraceptive and azelaic acid to assess their effect on sleep quality in adult female acne patients.
abstract: Several studies have reported an increase in the prevalence of adult female acne. This subtype of acne presents particular characteristics, and can be triggered by several factors such as smoking, stress, the use of oily cosmetics and even by poor sleep. Sleep quality is related to well-being and the maintenance of body homeostasis. In addition, several skin diseases present a bidirectional relationship with sleep, demonstrating an important connection between skin and the central nervous system. With this in mind, we aimed to compare the effect of two types of treatment for adult female acne (azelaic acid or a combined oral contraceptive) on sleep quality and on concentrations of stress hormones. Also, we proposed to assess the correlation of sleep and hormonal parameters with acne severity. In order to do this, 32 women underwent a clinical evaluation, completed the Pittsburgh Sleep Quality Index (PSQI) questionnaire and had their blood collected for hormone assays. These procedures were performed at baseline and after 6 months of treatment. At baseline there were no differences between the groups in terms of body mass index, age, acne severity and hormone concentrations. Results showed that both treatments demonstrated effectiveness but that women treated with azelaic acid presented a better sleep quality after the treatment compared to baseline and to the group treated with the combined oral contraceptive. The combined oral contraceptive group presented an increase in cortisol and a decrease in free testosterone concentration in relation to baseline. These data suggest that both azelaic acid and combined oral contraceptive are effective in the treatment of adult female acne but, azelaic acid seems to be a more suitable option for those women who may benefit from a better subjective sleep quality.
authors.affiliation: Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, 04024-002, São Paulo, SP, Brazil.
authors.forename: Rachel Gimenes
authors.initials: RG
authors.lastname: Albuquerque
authors.affiliation: Departamento de Dermatologia, Universidade Federal de São Paulo, Rua Borges Lagoa, 508, 04038-001, São Paulo, SP, Brazil.
authors.forename: Marco Alexandre Dias
authors.initials: MA
authors.lastname: da Rocha
authors.affiliation: Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, 04024-002, São Paulo, SP, Brazil.
authors.forename: Camila
authors.initials: C
authors.lastname: Hirotsu
authors.affiliation: Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, 04024-002, São Paulo, SP, Brazil.
authors.forename: Helena
authors.initials: H
authors.lastname: Hachul
authors.affiliation: Departamento de Dermatologia, Universidade Federal de São Paulo, Rua Borges Lagoa, 508, 04038-001, São Paulo, SP, Brazil.
authors.forename: Edileia
authors.initials: E
authors.lastname: Bagatin
authors.affiliation: Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, 04024-002, São Paulo, SP, Brazil.
authors.forename: Sergio
authors.initials: S
authors.lastname: Tufik
authors.affiliation: Departamento de Psicobiologia, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925, 04024-002, São Paulo, SP, Brazil. ml.andersen12@gmail.com.
authors.forename: Monica Levy
authors.initials: ML
authors.lastname: Andersen
mesh_terms: D000152:Acne Vulgaris / Q000188:drug therapy*; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D002490:Central Nervous System / Q000502:physiology; D003277:Contraceptives, Oral, Combined / Q000627:therapeutic use*; D003278:Contraceptives, Oral, Hormonal / Q000627:therapeutic use*; D003998:Dicarboxylic Acids / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D012879:Skin Physiological Phenomena; D012890:Sleep / Q000187:drug effects*; D000068776:Sleep Aids, Pharmaceutical / Q000627:therapeutic use*; D011795:Surveys and Questionnaires; D013739:Testosterone / Q000097:blood
chemical_list: D003277:Contraceptives, Oral, Combined; D003278:Contraceptives, Oral, Hormonal; D003998:Dicarboxylic Acids; D000068776:Sleep Aids, Pharmaceutical; D013739:Testosterone; D000324:Adrenocorticotropic Hormone; C010038:azelaic acid; D006854:Hydrocortisone
keywords: Acne; Azelaic acid; Cortisol; Drospirenone; Ethinyl estradiol; Sleep