Intervention Review

Combined oral contraceptive pills for treatment of acne

  1. Ayodele O Arowojolu1,*,
  2. Maria F Gallo2,
  3. Laureen M Lopez3,
  4. David A Grimes3,
  5. Sarah E Garner4

Editorial Group: Cochrane Fertility Regulation Group

Published Online: 8 JUL 2009

Assessed as up-to-date: 29 JAN 2009

DOI: 10.1002/14651858.CD004425.pub4

Database Title

Additional Information

How to Cite

Arowojolu AO, Gallo MF, Lopez LM, Grimes DA, Garner SE. Combined oral contraceptive pills for treatment of acne. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD004425. DOI: 10.1002/14651858.CD004425.pub4.

Author Information

  1. 1

    College of Medicine, University College Hospital, Department of Obstetrics and Gynaecology, Ibadan, Oyo State, Nigeria

  2. 2

    Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia, USA

  3. 3

    Family Health International, Behavioral and Biomedical Research, Research Triangle Park, North Carolina, USA

  4. 4

    National Institute for Clinical Excellence, Appraisals Team, London, UK

*Ayodele O Arowojolu, Department of Obstetrics and Gynaecology, College of Medicine, University College Hospital, Ibadan, Oyo State, Nigeria. ayorowojolu@hotmail.com.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 8 JUL 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Acne is a common skin disorder among women. Although no uniform approach to the management of acne exists, combination oral contraceptives (COCs), which contain an estrogen and a progestin, often are prescribed for women.

Objectives

To determine the effectiveness of combined oral contraceptives (COCs) for the treatment of facial acne compared to placebo or other active therapies.

Search methods

We searched for randomized controlled trials of COCs and acne in the computerized databases of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, POPLINE, and LILACS. We also searched for clinical trials in ClinicalTrials.gov and the International Clinical Trials Registry Platform (ICTRP). We wrote to authors of identified trials to seek any unpublished or published trials that we might have missed.

Selection criteria

All randomized controlled trials reported in any language that compared the effectiveness of a COC containing an estrogen and a progestin to placebo or another active therapy for acne in women were eligible.

Data collection and analysis

We extracted data on total and specific (i.e., open or closed comedones, papules, pustules and nodules) facial lesion counts; acne severity grades; global assessments by the clinician or the participant and discontinuation due to adverse events. Data were entered and analyzed in RevMan.

Main results

The search yielded 25 trials: 7 placebo-controlled trials made 4 different comparisons, 17 trials made 13 comparisons between 2 different COC regimens, and 1 additional trial compared a COC to an antibiotic. COCs reduced acne lesion counts, severity grades and self-assessed acne compared to placebo. Differences in the comparative effectiveness of COCs containing varying progestin types and dosages, though, were less clear. COCs that contained chlormadinone acetate or cyproterone acetate improved acne better than levonorgestrel, although this apparent advantage was based on limited data. A COC with cyproterone acetate might result in better acne outcomes than one with desogestrel; however, the three studies comparing these COCs produced conflicting results. Likewise, levonorgestrel showed a slight improvement over desogestrel in acne outcomes in one trial, but a second trial found the COC groups were similar.

Authors' conclusions

The four COCs evaluated in placebo-controlled trials are effective in reducing inflammatory and non-inflammatory facial acne lesions. Few important differences were found between COC types in their effectiveness for treating acne. How COCs compare to alternative acne treatments is unknown since limited data were available regarding this question.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Effect of birth control pills on acne in women

Acne is a common skin problem for women. Several treatments are available. Combined birth control pills, which have the hormones estrogen and progestin, are often prescribed for women with acne. This review looked at how well birth control pills worked to treat facial acne.

We did a computer search for studies of birth control pills and acne treatment. Outcomes could be the amount of acne, how severe the acne was, and how many women dropped out early due to problems. We wrote to researchers to find other trials. We included randomized trials in any language that compared two types of birth control pills, a pill and a placebo or 'dummy,' or a pill and another acne treatment.

We found 25 trials: 7 trials used 'dummies,' 17 compared different types of birth control pills, and 1 compared a pill and an antibiotic. The three pills studied in trials with dummies worked well to reduce facial acne. In comparing pills with different hormones, no important differences were seen.

The conclusions did not change when we added trials in this update to the other studies. Most trials compared two types of pills for acne treatment. Better quality studies are needed to compare one birth control pill with another. How birth control pills compare to other acne treatments like antibiotics is unclear. Since birth control pills improve acne, they can be used to treat women with acne who also want birth control.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

使用複方口服避孕藥治療痤瘡

痤瘡是一種婦女常見的皮膚疾病。雖然沒有標準的治療痤瘡的方式，但複方的口服避孕藥，包含一種雌激素和一種黃體素，常被用來治療婦女的痤瘡。

目標

決定與安慰劑或其他的治療方法相比，複方的口服避孕藥用於治療面部痤瘡的效果。

搜尋策略

我們搜尋了Cochrane Central Register of controlled trails(CENTRAL)、MEDLINE、EMBASE、POPLINE、Biological Abstracts以及 LILACS等關於複方口服避孕藥與痤瘡的隨機對照試驗。我們也寫信給作者以確保不會錯失任何未發表或出版的實驗。

選擇標準

所有任何語言的隨機對照實驗報告，只要是用來比較含有雌激素和黃體素的複方口服避孕藥與安慰劑或與另一種積極的婦女痤瘡療法之效果的均納入。

資料收集與分析

我們設法得到全部或是各項臉部病灶的計數(即粉刺，丘疹，膿皰和結節);痤瘡嚴重程度等級;臨床醫師的評估或參與者因不良反應而停止使用等。數據資料輸入RevMan進行分析。

主要結論

我們總共搜索到了23個試驗：5個安慰劑對照試驗取得了3個不同的結果，在比較2種不同的複方口服避孕藥的17個試驗中得到了13項的結果，另1個試驗是比較複方口服避孕藥與抗生素產生的結果。複方口服避孕藥與安慰劑相比，可以減少痤瘡病數，嚴重等級和自覺改善率，但不同的複方口服避孕藥之間的效果目前的研究還不是很清楚，含有chlormadinone acetate或cyproterone acetate的複方口服避孕藥治療痤瘡的效果優於含有levonorgestrel的複方口服避孕藥，儘管這種明顯的優勢是基於有限的數據。含有cyproterone acetate的複方口服避孕藥治療痤瘡的效果可能比含有desogestrel的複方口服避孕藥好一些，但是，三項研究比較這幾種複方口服避孕藥產生矛盾的結果。同樣，含有levonorgestrel的複方口服避孕藥在一個研究中比含有desogestrel的複方口服避孕藥效果好，但在另一個研究中又沒有看到這樣的情形。

作者結論

三個比較複方口服避孕藥與安慰劑的對照實驗上發現避孕藥有效地減少炎症和非炎症的面部痤瘡病變。但若比較不同類型的複方口服避孕藥之間治療痤瘡的效果只有些微的差異。在比較複方口服避孕藥與替代療法之間的優劣這個問題，因為只有有限的實驗數據，目前仍是未知數。

翻譯人

本摘要由臺灣大學附設醫院林思宏翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

痤瘡對婦女來說是一種常見的皮膚問題，治療痤瘡的方法有好幾種。複方的口服避孕藥(含有雌激素和黃體素)往往會用來治療婦女的痤瘡。本次的回顧研究著重於複方口服避孕藥治療面部痤瘡的效果到底有多好.我們搜索了關於避孕藥和痤瘡治療的研究。結果可能是粉刺的數量，痤瘡的嚴重程度，有多少婦女因為使用上的問題而放棄。我們寫信給研究人員試圖找到其他的研究。我們找的隨機試驗包括任何語言，只要是比較兩種類型的避孕藥，避孕藥和安慰劑或避孕藥與另一種痤瘡的治療方法。共23個研究被我們發現，其中5個試驗比較安慰劑，17個試驗比較不同類型的避孕藥之間的效果，有1個試驗是比較避孕藥與抗生素。在三個安慰劑研究當中，避孕藥有效的減少面部痤瘡。但在比較了不同程份的避孕藥上並沒有發現不同.即使我們增加了2個新的研究，比起其他21個研究也沒有差別。大多數的研究都是比較兩種不同類型的複方口服避孕藥對於治療痤瘡上的差異。但需要更好更有質量的研究才可得知之間的差異。避孕藥與抗生素治療痤瘡之間的優劣目前仍不清楚。所以由於避孕藥可以改善痤瘡，它們可以被用來治療有痤瘡問題也想控制生育的婦女。

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