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Ortho Tri-Cyclen for Acne Vulgaris

Androgens stimulate acne vulgaris through excess production or enhanced sebaceous gland activation. Estrogen-containing oral contraceptives (OCs) improve acne in women because they suppress pituitary gonadotropin secretion and, therefore, decrease the production of ovarian androgens. Estrogens also increase circulating sex hormone - binding globulin, which binds testosterone and reduces levels of free testosterone. The newer progestins, such as norgestimate, are minimally androgenic and show negligible binding to androgen receptors. OCs containing a combination of estrogen plus a minimally androgenic progestin have been found effective in the treatment of acne in women.

In the first randomized, placebo-controlled trial of an OC for treating acne, investigators from 12 centers evaluated 250 women (ages 15 to 49 years) with moderate acne. Patients in the active treatment group received Ortho Tri-Cyclen, a triphasic combination of norgestimate and ethinyl estradiol. The six-month study was completed by 164 patients. The OC group fared significantly better than the placebo group in all outcome measures, including mean reduction in inflammatory lesions (51% vs. 35%), mean reduction in total lesions (46% vs. 34%), and percentage of patients judged to have improved (83% vs. 63%). In the OC group only, levels of free testosterone decreased and levels of sex hormone - binding globulin increased significantly. The clinical benefits were apparent at three months.

Comment: The overall effect of the combination of norgestimate and ethinyl estradiol, which is essentially anti-androgen, is to decrease circulating androgens and thus improve acne. Although often underused in female acne patients, OCs containing a low dose of estrogen in combination with a progestin can be very effective. These include OCs containing norgestimate as the progestin (Ortho-Cyclen and Ortho Tri-cyclen) as well as those containing desogestrel (Desogen and Ortho-Cept), ethynodiol diacetate (Demulen 1/35), and gestodene (not available in the U.S.).

This trial was supported by the manufacturer of the OC studied.

— K Wiss

Published in Journal Watch Dermatology June 1, 1997

Citation(s):

Redmond GP et al. Norgestimate and ethinyl estradiol in the treatment of acne vulgaris: A randomized, placebo-controlled trial. Obstet Gynecol 1997 89 615-622.

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