Taking the pill to tackle acne

Updated on ,validated by the medical directorate.

What can you do about acne on a daily basis?

When faced with persistent acne, the contraceptive pill may be seen as an effective solution. But why is the pill prescribed to treat acne? What type of anti-acne pill is it? Is this option suitable for all types of acne? And are there any long-term side effects? 

Today, doctors prescribe it with greater caution, reserving this option for specific cases and as part of a comprehensive treatment plan. 

In this article, discover the main answers to your questions about acne medication. 

Hormonal acne in women

Hormonal acne affects many women, up to 54% of adult women(1). It is a form of acne linked to:

  • hormonal fluctuations during the menstrual cycle(2): Hormonal acne is often exacerbated before menstruation, when oestrogen levels drop and progesterone dominates.
  • hormonal imbalances (particularly androgen, LH, FSH) and lipid imbalances (high triglycerides, insulin resistance)(3). 

These hormonal imbalances stimulate sebum production in the sebaceous glands and promote inflammation, often resulting in spots on the lower part of the face (chin, jawline). Endocrine disruptors present in the environment could also exacerbate this imbalance(4-5).

To remedy this, targeted hormone treatments, such as spironolactone, which reduces the effects of androgens, or certain suitable contraceptive pills (pills to tackle acne), can help manage hormonal acne in women(6). These options are particularly considered when traditional treatments are not effective. 

Hormonal acne in women

How does the pill work to tackle acne?

The pill, particularly the combined contraceptive pill (known by the abbreviation COC for combined oral contraceptives), is frequently prescribed to combat hormonal acne in women(7). These pills contain oestrogens and progestogens that help to combat acne. 

In fact, these pills for acne work by regulating androgen levels, which are responsible for excess sebum. A meta-analysis(7) of 32 clinical trials showed that these anti-acne pills reduce inflammatory lesions by 62% after 6 months, compared to 26% with a placebo and 58% with oral antibiotics. By reducing sebum production, these combined contraceptive pills, prescribed as anti-acne pills, significantly reduce inflammatory acne lesions (such as papules and pustules) and non-inflammatory lesions (comedones). 

In addition, spironolactone, although not a contraceptive pill, is often used to treat hormonal acne in adolescents with endocrine imbalances. Other options such as clasosterone(8), a recent topical treatment, also offer promising alternatives. 

However, these pills offer a practical two-in-one solution for women who wish to combine acne treatment with contraception. 

Side effects and precautions

Contraceptive pills for acne are an effective option, but they can sometimes cause side effects, often temporary, which prompt some women to stop their treatment(9). 
These effects include mood swings, unpredictable bleeding or, in some cases, worsening acne, particularly with progestogen-only pills(10).
Good news: for those affected, switching to combined hormonal contraception (oral contraceptives, contraceptive patches, vaginal rings, etc.) can not only improve skin quality, but also stabilise mood and reduce headaches associated with hormone-free phases(10).
In the event of irregular bleeding or other discomfort, adjusting the treatment, such as trying a combined contraceptive pill for 3 months, can often resolve the issue. Each case is unique, and regular medical monitoring is essential(10). 

Taking the pill for acne

Which pill for acne is right for me?

If you suffer from acne, inform your doctor if you are taking contraceptive pills or undergoing hormonal or medical treatment.

If acne appears, persists or worsens, or if conventional treatments do not work, there may be a link between the pill and your symptoms. In this case, your doctor may be able to offer you a more suitable pill. Please note that stopping the pill without medical advice is not recommended, as this will negate its contraceptive effect. 

Combined oral contraceptives (COCs) are frequently prescribed to treat hormonal acne, particularly in women with excess androgens or polycystic ovary syndrome (PCOS)(11). These tablets reduce sebum production and acne lesions.

In addition, spironolactone(12), an oral anti-androgen, may also be prescribed for adult women when other treatments, such as antibiotics, are insufficient or poorly tolerated.

An innovative alternative is clascosterone(8), a topical cream suitable for men and women aged 12 and over, which blocks androgen receptors with promising effectiveness. 

These hormonal solutions are particularly useful for treating persistent acne. 

Medical consultation and prescription

To treat acne effectively, a medical consultation is essential. The doctor will be able to assess your type of acne, identify its causes and suggest a suitable treatment. This may include a prescription for suitable contraceptive pills, other hormonal treatments, or topical treatments.

Never stop treatment without medical advice, especially if you are using contraceptive pills, as this could compromise their effectiveness. Regular follow-ups with your doctor ensure optimal care and adjustments if necessary. 

Tips for preventing acne breakouts

To prevent acne breakouts, first and foremost:

  • In terms of diet, opt for foods with a low glycaemic index and limit dairy products, while favouring foods rich in omega-3 such as oily fish(13). 
  • In terms of skincare, use gentle foaming gels and non-comedogenic products specifically designed for acne-prone skin(14). Consider applying a daily treatment, such as an anti-blemish serum containing glycolic acid. Finally, avoid occlusive make-up (which forms a film over the skin).

After stopping the pill: will I get acne again?

Stopping the hormonal contraceptive pill can cause skin changes, including a recurrence of acne in some people. These effects can be explained by a temporary hormonal imbalance, as the body has to adapt to the withdrawal of synthetic hormones(10). However, direct evidence linking this discontinuation to worsening acne remains limited. Side effects, including acne, are often temporary. 

If you experience a significant breakout after stopping the pill, you should consult with a healthcare professional to discuss appropriate solutions, such as specific skincare products or alternative hormone treatments. 

Sources :  
 

(1) Dréno B, Nguyen JM, Hainaut E, Machet L, Leccia MT, Beneton N, Claudel JP, Célérier P, Le Moigne M, Le Naour S, Vrignaud F, Poinas A, Dert C, Boisrobert A, Flet L, Korner S, Khammari A. Efficacy of Spironolactone Compared with Doxycycline in Moderate Acne in Adult Females: Results of the Multicentre, Controlled, Randomized, Double-blind Prospective and Parallel Female Acne Spironolactone vs doxyCycline Efficacy (FASCE) Study. Acta Derm Venereol. 2024 Feb 21;104:adv26002. doi: 10.2340/actadv.v104.26002. PMID: 38380975; PMCID: PMC10910526. 
(2) Hartono, L., Kapantow, M., & Kairupan, T. (2021). Pengaruh Menstruasi terhadap Akne Vulgaris. e-CliniC.  
(3) Szybiak, W., Jarzemska, M., Kowalczyk, M., Sadowska-Przytocka, A., Więckowska, B., Żaba, R., & Lacka, K. (2023). Selected hormone levels and lipid abnormalities in patients with acne vulgaris. Advances in Dermatology and Allergology/Postȩpy Dermatologii i Alergologii, 40, 798 - 807.  
(4) Rao, A., Douglas, S., & Hall, J. (2021). Endocrine Disrupting Chemicals, Hormone Receptors, and Acne Vulgaris: A Connecting Hypothesis. Cells, 10.  
(5) Kaya Ozden H, Karadag AS. Could endocrine disruptors be a new player for acne pathogenesis? The effect of bisphenol A on the formation and severity of acne vulgaris: A prospective, case-controlled study. J Cosmet Dermatol. 2021 Nov;20(11):3573-3579. doi: 10.1111/jocd.14364. Epub 2021 Aug 11. PMID: 34379355. 
(6) Herdiana, Y., Budiastuti, A., Riyanto, P., Malik, D., Widayati, R., , M., & , H. (2021). Effectiveness of Hormone Based Therapies (Spironolactone and Combined Oral Contraceptives in the Management of Acne Vulgaris in Women: A Systematic review and meta-analysis.  
(7) Eichenfield, D., Sprague, J., & Eichenfield, L. (2021). Management of Acne Vulgaris: A Review.. JAMA, 326 20, 2055-2067 .  
(8) Barbieri, J. (2020). A New Class of Topical Acne Treatment Addressing the Hormonal Pathogenesis of Acne.. JAMA dermatology.  
(9) Guen, L., Schantz, C., Régnier-Loilier, A., & De La Rochebrochard, E. (2021). Reasons for rejecting hormonal contraception in Western countries: A systematic review.. Social science & medicine, 284, 114247 .  
(10) Boog, K. (2021). Managing the side effects of contraception. Journal of Prescribing Practice.  (11) Daghash, R. (2020). Acne Management in Polycystic Ovary Syndrome (Review article). 
(12) Poinas, A., Lemoigne, M., Naour, L., Nguyen, J., Schirr-Bonnans, S., Riche, V., Vrignaud, F., Machet, L., Claudel, J., Leccia, M., Hainaut, E., Bénéton, N., Dert, C., Boisrobert, A., Flet, L., Chiffoleau, A., Corvec, S., Khammari, A., & Dréno, B. (2020). FASCE, the benefit of spironolactone for treating acne in women: study protocol for a randomized double-blind trial. Trials, 21.  
(13) Baldwin, H., & Tan, J. (2020). Effects of Diet on Acne and Its Response to Treatment. American Journal of Clinical Dermatology, 22, 55 - 65.  
(14) Lain, E., & Andriessen, A. (2020). Choosing the Right Partner: Complementing Prescription Acne Medication With Over-the-Counter Cleansers and Moisturizers.. Journal of drugs in dermatology : JDD, 19 11, 1069-1075.

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