Research Article of American Journal of Dermatological Research and Reviews
Effectiveness of Hormone Based Therapies (Spironolactone and Combined Oral Contraceptives in the Management of Acne Vulgaris in Women: A Systematic review and meta-analysis
Yulita Herdiana*, Asih Budiastuti, Puguh Riyanto, Diah Adriani Malik, Retno Indar Widayati, Muslimin, Hardian
Department of Dermatovenereology, Faculty of Medicine, Diponegoro University/Dr. Kariadi Hospital, Dr. Sutomo Street No. 16, Semarang, Indonesia.
Department of Physiology, Faculty of Medicine, Diponegoro University
Background: Acne vulgaris (AV) is a chronic inflammatory disease of the pilosebaceous follicular unit that often occurs. Acne is a skin disorder that is not life-threatening but is mostly complained of because it is aesthetically disruptive, which can cause significant psychological problems for sufferers. The management of acne vulgaris in female patients has its challenges. There are many histories of failed therapy using conventional therapy, such as with antibiotics or isotretinoin, and female patients have a predisposition to the condition of androgen excess. Also, the increasing awareness about limiting the use of antibiotics to prevent resistance in dermatological cases, including acne vulgaris, encourages other treatment options in the female patient population, one of which is hormone-based therapy. A systematic review and meta-analysis were performed of randomized clinical trials assessing the effects of Hormone Based Therapies (Spironolactone and Combined Oral Contraceptives) in the management of Acne Vulgaris in Women.
Methods: Medline Pubmed, Scopus, Cochrane Library, the reference list, conference proceedings, researchers in the field of eligible studies were searched. Ten studies (n=1906 sub-jects) were included in qualitative analysis, of which eight studies (n=1842 subjects) were included in the meta-analysis. The age of the participant was greater than 14 years old. Intervention using combined oral contraceptives (n=8) or oral spironolactone (n=2). Duration of intervention (minimum six months for COC and three months for SL) and outcomes of mean difference number of acne vulgaris lesions before and after treatment.
Results: Pooling of data using random-effects model found a significant difference in the mean difference in the number of lesions after treatment in the group receiving hormone-based therapy (spironolactone and combined oral contraceptives) and those receiving control therapy (p = 0.005). The overall mean difference was -0.890 ± 0.316. A negative value indicating the number of lesions after hormone-based therapy (spironolactone and combined oral contraceptives) was significantly lower than those receiving control therapy (p = 0.005).
Conclusion: From the results of the systematic review and meta-analysis conducted, it can be concluded that in the group given hormone-based therapy (spironolactone and Combined Oral Contraceptives), there was a decrease in the total number of acne vulgaris lesions compared to before treatment, and the mean difference in the number of lesions was significantly lower after getting hormone-based therapy (spironolactone and combined oral contraceptives) compared with controls.
Keywords: hormone-based therapy; spironolactone; Combined Oral Contraceptives; Acne Vulgaris
How to cite this article:
Yulita Herdiana*, Asih Budiastuti, Puguh Riyanto, Diah Adriani Malik, Retno Indar Widayati, Muslimin, Hardian.Effectiveness of Hormone Based Therapies (Spironolactone and Combined Oral Contraceptives in the Management of Acne Vulgaris in Women: A Systematic review and meta-analysis. American Journal of Dermatological Research and Reviews, 2021, 4:42. DOI: 10.28933/ajodrr-2021-04-1805
1. Carolyn Goh, Carol Cheng GA, Andrea L. Zaenglein EMG. Acne Vulgaris. In: Fitzpatrick’s Dermatology 9 ed. 2019. p. 1391–418.
2. Hastuti R, Mustifah EF, Alya I, Risman M, Mawardi P. The effect of face washing frequency on acne vulgaris patients. J Gen Dermatology Venereol Indones. 2019;3(2):35–40.
3. Susanto SD. Epidemiology akne. In: Seminar dan Workshop penanganan akne. Semarang; 2009.
4. Kucharska A, Szmurło A, Sinska B. Significance of diet in treated and untreated acne vulgaris. Postep Dermatologii i Alergol. 2016;33(2):81–6.
5. Dreno B, Thiboutot D, Gollnick H, Bettoli V, Kang S, Leyden JJ, et al. Antibiotic stewardship in dermatology: Limiting antibiotic use in acne. Eur J Dermatology. 2014;24(3):330–4.
6. Salvaggio HL, Zaenglein AL. Examining the use of oral contraceptives in the management of acne. Int J Women’s Health. 2010;2(1):69–76.
7. 7. Katsambas AD, Dessinioti C. Hormonal therapy for acne: why not as first-line therapy? Facts and controversies. Clin Dermatol [Internet]. 2010;28(1):17–23. Available from: http://dx.doi.org/10.1016/j.clindermatol.2009.03.0 06
8. George R, Clarke S TD. Hormonal therapy for acne. Semin Cutan Med Surg. 2008;27:188–196.
9. Ebede TL, Arch EL, Berson D. Hormonal treatment of acne in women. J Clin Aesthet Dermatol. 2009;2(12):16–22.
10. Moher D, Liberati A, Tetzlaff J, Altman DG, Altman D, Antes G, et al. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med. 2009;6(7).
11. Higgins J, Thomas J. Collecting data – form for RCTs only. In: Higgins J, Thomas J, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 510 [Internet]. The Cochrane Collaboration; 2011. Available from: https://training.cochrane.org/data-collection-form-rcts
12. Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343(7829):1–9.
13. Jaisamrarn U, Santibenchakul S. A comparison of combined oral contraceptives containing chlormadinone acetate versus drospirenone for the treatment of acne and dysmenorrhea: a randomized trial. Contracept Reprod Med. 2018;3(1):1–9.
14. Jaisamrarn U, Chaovisitsaree S, Angsuwathana S, Nerapusee O. A comparison of multiphasic oral contraceptives containing norgestimate or desogestrel in acne treatment: A randomized trial. Contraception. 2014;90(5):535–41.
15. Rosen MP, Breitkopf DM, Nagamani M. A randomized controlled trial of second- versus third-generation oral contraceptives in the treatment of acne vulgaris. Am J Obstet Gynecol. 2003;188(5):1158–60.
16. Thiboutot D, Archer DF, Lemay A, Washenik K, Roberts J, Harrison DD. A randomized, controlled trial of a low-dose contraceptive containing 20 μg of ethinyl estradiol and 100 μg of levonorgestrel for acne treatment. Fertil Steril. 2001;76(3):461–8.
17. Vartiainen M, De Gezelle H, Broekmeulen CJH. Comparison of the effect on acne with a combiphasic desogestrel-containing oral contraceptive and a preparation containing cyproterone acetate. Eur J Contracept Reprod Heal Care. 2001;6(1):46–53.
18. Lucky AW, Henderson TA, Olson WH, Robisch DM, Lebwohl M, Swinyer LJ. Effectiveness of norgestimate and ethinyl estradiol in treating moderate acne vulgaris. J Am Acad Dermatol. 1997;37(5 I):746–54.
19. Leyden J, Shalita A, Hordinsky M, Swinyer L, Stanczyk FZ, Weber ME. Efficacy of a low-dose oral contraceptive containing 20 μg of ethinyl estradiol and 100 μg of levonorgestrel for the treatment of moderate acne: A randomized, placebo-controlled trial. J Am Acad Dermatol. 2002;47(3):399–409.
20. Redmond GP, Olson WH, Lippman JS, Kafrissen ME, Jones TM, Jorizzo JL. Norgestimate and ethinyl estradiol in the treatment of acne vulgaris: A randomized, placebo-controlled trial. Obstet Gynecol. 1997;89(4):615–22.
21. Muhlemann MF, Carter GD, Cream JJ, Wise P. Oral spironolactone: an effective treatment for acne vulgaris in women. Br J Dermatol. 1986;115(2):227–32.
22. Yemisci A, Gorgulu A, Piskin S. Effects and side-effects of spironolactone therapy in women with acne. J Eur Acad Dermatology Venereol. 2005;19(2):163–6.
23. Kim GK, Del Rosso JQ. Oral spironolactone in post-teenage female patients with acne vulgaris: Practical considerations for the clinician based on current data and clinical experience. J Clin Aesthet Dermatol. 2012;5(3):37–50.
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