P-26   ORAL CONTRACEPTIVES, HORMONE REPLACEMENT THERAPY AND ANDROGEN SENSITIVE SKIN DISORDERS

I. Ali, RP Dawber Department of Dermatology, Oxford Radcliffe Hospitals, UK.

Oral contraceptive pills (OCP) and hormone replacement therapy (HRT) are amongst the most commonly used drugs by women. Their effect on androgen sensitive skin disease is paradoxical in that they can act as both exacerbating factors and serve as therapeutic agents. These conflicting properties can be related to the androgenicity of the progestogen contained in the preparation. Progestogens have varying androgenic properties depending on their chemical derivation. Older combined contraceptive pills contained higher levels of oestrogen which was later reduced to decrease the risk of thrombo-embolic disease. As the oestrogen dose was reduced the androgenic properties of the progestogen became more apparent and newer progestogens were developed with less androgenic properties such as gestodene, desogestrel and norgestimate.1 The anti androgenic progestogen, cyproterone acetate has been available since the 1940’s and is the most established progestogen in the treatment of androgen sensitive skin disease. It is available as a combined oral contraceptive pill, Dianette(r) and as a HRT preparation, Climen(r). Recently a new progestogen with anti androgenic properties has been released on to the market called drospirenone. It has similar efficacy to cyproterone acetate in the treatment of acne and has beneficial effects on hirsutism.2 The availability of new drugs further expands the options of OCP preparations available for the female patient. Improved understanding of the components in OCPs and HRT can enable the dermatologist to gain maximum benefits from these as pharmacotherapies and suggest possible alternatives when faced with common side effects.

References:

1. P D Darney.The androgenicity of progestins. Am J Med 98 (1A):104-110

2. Van Vloten WA et al.The effect of 2 combined oral contraceptives containing either drospirenone or cyproterone acetate on acne and seborrhea. Cutis, 2002 (4 Suppl): S2-15.