Oral contraceptives can be prescribed as adjuncts to therapies such as topical retinoids or oral isotretinoin to treat acne, and it is up to clinicians to inform their patients of any risks in taking systemic hormonal treatments.
"Hormonal therapy doesn't necessarily treat acne," says Diane Berson, M.D., assistant clinical professor of dermatology, Weill Cornell Medical College, New York. "It is something that is given to prevent further breakouts. You would still give it along with the traditional therapies, whether they are topical or oral. It can be given as a first-line therapy if it is an adjunct (to traditional therapy). It is not a stand-alone monotherapy."
Dr. Berson noted that any kind of hormonal change can elicit a flare of acne. "It can be going on the (birth control) pill, going off the pill, having a baby, perimenopause and even menopause," Dr. Berson says.
"If there are flares during the week before their period, especially if they are getting cysts on their chin during that time, that would suggest a hormonal component," Dr. Berson says. "In that situation, you might prescribe a birth control pill along with their standard regimen."
Side effects of the pill are less common than in the past, since lower doses of estrogen are now administered, Dr. Berson says.
"Most of the side effects are due to the estrogen component," Dr. Berson says. "In the past, you could have a little nausea, headaches and breast swelling. There is still potential for deep vein thrombosis and vascular events, though these complications may be less likely to occur now."
Hormonal therapy in the form of oral contraceptives is contraindicated in patients who have a history of blood clotting disorders, migraines, high blood pressure, smoking or heart disease, Dr. Berson says, adding that smoking increases the risk for complications.
"You want to make sure that they understand the potential risks, such as blood clots," she says. "There are some gynecologists who like to do a clotting work-up of patients over the age of 40. Any of the potential risks of the pill are increased when you get older."
Following a number of lawsuits alleging side effects, some legal groups are encouraging women who have used the oral contraceptives Yaz (drospirenone and ethinyl estradiol, Bayer HealthCare), Yasmin (estrogen and progestin, Bayer HealthCare) or Ocella (drospirenone and ethinyl estradiol, Barr) to seek compensation for side effects arising by filing suit.
"Any birth control pill carries risks," Dr. Berson says.