Are Oral Contraceptives Underutilised in the Treatment of Acne in the United States?
Presented at AAD
Source: DGNews
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By John Schieszer
SAN DIEGO -- March 20, 2012 -- Oral contraceptives are a safe, effective treatment for acne, and may be underutilised by dermatologists in the United States, according to study results presented here at the 70th Annual Meeting of the American Academy of Dermatology (AAD).
“We are underutilising one of our effective tools,” stated Steve Feldman, MD, PhD, Wake Forest University School of Medicine, Winston Salem, North Carolina, speaking here on March 17. “Education is an issue. A lack of comfort is part of the problem as well. Putting a child on a birth control may imply something about their sexual activity when it is not being used that way.”
Dr. Feldman and colleagues wanted to compare use of oral contraceptives with use of isotretinoin, and to determine whether adequate use and documentation of oral contraceptives are occurring among patients treated with isotretinoin. The team queried the National Ambulatory Medical Care Survey database for acne visits by females aged 12 to 55 years from 1993 to 2008. The resulting visits were analysed for physician specialty and oral contraceptives and isotretinoin use.
Isotretinoin was found more likely to be prescribed than an oral contraceptive at first visits for acne (4.7% compared with 3.3%) and all visits for acne (6.6% compared with 1.5%). Dr. Feldman said oral contraceptive use or other contraceptive use was documented at only 7.5% of visits in which isotretinoin was being prescribed.
Additionally, obstetricians/gynaecologists prescribed oral contraceptives for acne more frequently than dermatologists (19.6% compared with 1.2%). The obstetricians/gynaecologists also prescribed isotretinoin more frequently than dermatologists (15.2% compared with 7.1%) and obstetricians/gynaecologists documented concurrent contraceptive use for isotretinoin patients more often than did dermatologists (43.5% compared with 2.7%).
Dr. Feldman and colleagues concluded that a trial of oral contraceptives might be indicated among all appropriate female patients with acne, prior to initiating isotretinoin therapy. They also found that providers prescribing isotretinoin should be more vigilant about proper documentation of contraceptive use among isotretinoin patients at every visit.
Combination oral contraceptives have been found to effectively clear acne in women either when used alone or in conjunction with an anti-androgen medication, such as spironolactone. Many different oral contraceptives have been shown to be effective in treating acne. Oral contraceptives approved by the US Food and Drug Administration (FDA) for the treatment of hormonal acne contain ethinyl oestradiol plus either the progestin norgestimate, norethindrone acetate, or drospirenone.
[Presentation title: Oral Contraceptives May Be Underutilized in the Treatment of Acne in the United States. Abstract 5408]