Hormonal anti-androgen acne treatment (HAAT), including combined oral contraceptives (COCs) and spironolactone, is a useful alternative to systemic antibiotics in women with acne, according to the results of a 10-year retrospective study conducted at the Ronald O. Perelman department of dermatology, New York University Langone Health, in New York City, published in the American Journal of Clinical Dermatology.

The investigators sought to examine the HAAT-prescribing habits of dermatologists and the impact associated with the use of HAAT on systemic antibiotic therapy in women with acne. Female patients with acne who received HAAT (COCs and spironolactone) at an academic medical center between January 2005 and October 2015 were evaluated. Data from a control group of women who had never received HAAT were also obtained.

A total of 672 women received HAAT and 103 women served as controls. The mean patient age at presentation was 25.2 (range, 14 to 59). Of all systemic medications for the treatment of acne, antibiotics were used as first-line therapy in 39% of patients, COCs in 12%, and spironolactone in 21%.

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The mean duration of antibiotic use in women who initiated HAAT for the first time at the study site was significantly longer than the duration of antibiotic use in women who had received HAAT prior to presentation and continued HAAT at the study site (250.4 days vs 192.0 days, respectively; P =.021). There was a statistically significant inverse association reported between the use of HAAT and mean antibiotic duration
(P =.016). 

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The investigators concluded that although HAAT is not typically used as a first-line systemic therapy in women with acne, HAAT usage is linked to shorter cumulative antibiotic duration. Furthermore, early HAAT initiation can decrease the use of systemic antibiotics in women with acne. In an effort to promote more responsible use of antibiotics by dermatologists, HAAT is being recognized as a promising therapy in women with acne.


Park JH, Bienenfeld A, Orlow SJ, Nagler AR. The use of hormonal antiandrogen therapy in female patients with acne: a 10-year retrospective study. Am J Clin Dermatol. 2018;19(3):449-455.