Oral contraceptives are an established part of acne management, especially in post adolescent women. However, I have seen a few cases where some oral contraceptive brands exacerbate acne and hair loss.
The progesterone components of some OCPs have androgenic (testosterone-like) properties. Androgenic properties can make acne worse. For example, they can cause hair loss in individuals genetically vulnerable to alopecia. I have been recommending orthotricyclen with 35 micrograms of estrogen for female adult acne patients for years. But I failed to realize that the progesterone component is less androgenic.
While reviewing a recent case of a young patient with significant alopecia, further history revealed that she had been on oral contraceptives for years. I had done a full work up on her three years ago, but failed to get the history of birth control use. Some patients don’t consider it a medication. The progestin in this particular brand is in the mid range of androgenicity; it has been associated with hair loss in about 2% of women. I have contacted this patient’s PCP to see if she can be prescribed a contraceptive with less androgenicity.
Osathanondh, R, Stelluto, MR, Carlson, KJ. Contrception. In: Primary Care of Women, Carson KJ, Eisenstadt(eds), Mosby, St. Lois, 1995. In UptoDate