Oral Contraceptives and Acne: Do Dermatologists Understand the Risks?
Some reports indicate that oral contraceptives (OCPs) are as effective as systemic antibiotics in reducing inflammatory, noninflammatory, and total facial acne lesions, and the American Academy of Dermatology gives OCPs a grade A recommendation based on consistent and good-quality patient-oriented evidence.
However, despite this endorsement, some studies have shown that dermatologists prescribed OCPs in only 2% of visits with female patients who presented for acne treatment. The FDA has approved 3 OCPs for the treatment of acne in adult women plus an additional class of OCPs, drospirenone-containing OCPs (DCOCPs), which contain the only FDA-approved progestin that blocks androgen receptors. Despite research that shows treatment with DCOCPs as associated with greater reductions in total lesion count and investigator-graded acne severity compared to early-generation OCPs, DCOCPs are also associated with a greater risk for adverse effects such as venous thromboembolism (VTE).
A recent study surveyed US dermatologists about their knowledge, comfort, and prescribing practices pertaining to the use of OCPs. The study compares OCP-prescribing to nonprescribing dermatologists, and those frequently prescribing DCOCPs to those who infrequently prescribe DCOCPs. The results showed that 95.4% of respondents believed that OCPs were effective in the treatment of acne. 94.2% believed OCPs were associated with an increased risk for VTE, and 46.4% believed DCOCPs posed a greater VTE risk than other OCPs. Dermatologists who prescribed OCPs for acne were able to correctly identify CDC-defined absolute contraindications such as high blood pressure, history of migraine with focal neurologic symptoms, and history of deep vein thrombosis or pulmonary embolism.
Despite understanding effectiveness and risks, the results showed that only 54% of respondents reported prescribing them; nearly half of respondents seeing 25 or more acne patients weekly did not prescribe OCPs, suggesting a notable practice gap. Dermatologists in academic settings prescribed OCPs more frequently, suggesting greater comfort with the literature on the efficacy.
The authors wonder if exploring a greater comfort level in managing side effects would make dermatologists more likely to prescribe OCPs. In addition, they suggest future exploration of why many dermatologists do not prescribe OCPs despite believing they are effective for acne.
Byline: Martha L. Sikes, MS, RPh, PA-C
Posted: April 3, 2017
Adapted from the original article.