Editing Acne (section)

====Hormonal agents====
In women, the use of [[combined birth control pill]]s can improve acne.<ref name=Tyler2013>{{cite journal | vauthors = Arowojolu AO, Gallo MF, Lopez LM, Grimes DA | veditors = Arowojolu AO | title = Combined oral contraceptive pills for treatment of acne | journal = The Cochrane Database of Systematic Reviews | volume = 7 | issue = 7 | pages = CD004425 | date = July 2012 | pmid = 22786490 | doi = 10.1002/14651858.CD004425.pub6 | type = Systematic Review & Meta-Analysis | pmc = 11437354 }}</ref> These medications contain an [[estrogen (medication)|estrogen]] and a [[progestin]].<ref name="Kuhl1999" /> They work by decreasing the production of androgen hormones by the ovaries and by decreasing the free and hence biologically active fractions of androgens, resulting in lowered skin production of sebum and consequently reduce acne severity.<ref name="Aslam2015"/><ref name="pmid22994662">{{cite journal | vauthors = Kamangar F, Shinkai K | title = Acne in the adult female patient: a practical approach | journal = International Journal of Dermatology | volume = 51 | issue = 10 | pages = 1162–74 | date = October 2012 | pmid = 22994662 | doi = 10.1111/j.1365-4632.2012.05519.x | s2cid = 5777817 | doi-access = free }}</ref> First-generation progestins such as [[norethindrone]] and [[norgestrel]] have androgenic properties and may worsen acne.<ref name="Zaenglein2018"/> Although oral estrogens decrease IGF-1 levels in some situations, which could theoretically improve acne symptoms,<ref name="pmid16112947">{{cite journal | vauthors = Kuhl H | title = Pharmacology of estrogens and progestogens: influence of different routes of administration | journal = Climacteric | volume = 8 | pages = 3–63 | date = August 2005 | issue = Suppl 1 | pmid = 16112947 | doi = 10.1080/13697130500148875 | s2cid = 24616324 | url = http://hormonebalance.org/images/documents/Kuhl%2005%20%20Pharm%20Estro%20Progest%20Climacteric_1313155660.pdf | access-date = 21 December 2018 | archive-url = https://web.archive.org/web/20160822055012/http://hormonebalance.org/images/documents/Kuhl%2005%20%20Pharm%20Estro%20Progest%20Climacteric_1313155660.pdf | archive-date = 22 August 2016 | url-status = live }}</ref><ref name="pmid27704479">{{cite journal | vauthors = Duarte FH, Jallad RS, Bronstein MD | title = Estrogens and selective estrogen receptor modulators in acromegaly | journal = Endocrine | volume = 54 | issue = 2 | pages = 306–314 | date = November 2016 | pmid = 27704479 | doi = 10.1007/s12020-016-1118-z | s2cid = 10136018 }}</ref> combined birth control pills do not appear to affect IGF-1 levels in fertile women.<ref name="Kuhl1999">{{cite book |doi=10.1007/978-3-642-60107-1_18 |chapter=Hormonal Contraception |title=Estrogens and Antiestrogens II |series=Handbook of Experimental Pharmacology |year=1999 |last1=Kuhl |first1=H. |volume=135 / 2 |pages=363–407 |isbn=978-3-642-64261-6 }}</ref><ref name="Kuhl1997">{{cite journal |last1=Kuhl |first1=H. |title=Metabolische Effekte der Östrogene und Gestagene |journal=Der Gynäkologe |date=18 April 1997 |volume=30 |issue=4 |pages=357–369 |doi=10.1007/PL00003042 |s2cid=43381309 }}</ref> [[Cyproterone acetate]]-containing birth control pills seem to decrease total and free IGF-1 levels.<ref name="pmid15832490">{{cite journal | vauthors = Wiegratz I, Kuhl H | title = Managing cutaneous manifestations of hyperandrogenic disorders: the role of oral contraceptives | journal = Treatments in Endocrinology | volume = 1 | issue = 6 | pages = 372–86 | date = 2002 | pmid = 15832490 | doi = 10.2165/00024677-200201060-00003 | s2cid = 71806394 }}</ref> Combinations containing third- or fourth-generation [[progestin]]s, including [[desogestrel]], [[dienogest]], [[drospirenone]], or [[norgestimate]], as well as birth control pills containing cyproterone acetate or [[chlormadinone acetate]], are preferred for women with acne due to their stronger antiandrogenic effects.<ref name="pmid22786490">{{cite journal | vauthors = Arowojolu AO, Gallo MF, Lopez LM, Grimes DA  | veditors = Arowojolu AO | title = Combined oral contraceptive pills for treatment of acne | journal = The Cochrane Database of Systematic Reviews | issue = 7 | pages = CD004425 | date = July 2012 | pmid = 22786490 | doi = 10.1002/14651858.CD004425.pub6 | pmc = 11437354 }}</ref><ref name="Powell2017">{{cite journal | vauthors = Powell A | title = Choosing the Right Oral Contraceptive Pill for Teens | journal = Pediatric Clinics of North America | volume = 64 | issue = 2 | pages = 343–358 | date = April 2017 | pmid = 28292450 | doi = 10.1016/j.pcl.2016.11.005 | type = Review }}</ref><ref name="pmid29725277">{{cite journal | vauthors = Słopień R, Milewska E, Rynio P, Męczekalski B | title = Use of oral contraceptives for management of acne vulgaris and hirsutism in women of reproductive and late reproductive age | journal = Przeglad Menopauzalny = Menopause Review | volume = 17 | issue = 1 | pages = 1–4 | date = March 2018 | pmid = 29725277 | pmc = 5925193 | doi = 10.5114/pm.2018.74895 }}</ref> Studies have shown a 40 to 70% reduction in acne lesions with combined birth control pills.<ref name="pmid22994662" /> A 2014 [[systematic review|review]] found that oral antibiotics appear to be somewhat more effective than birth control pills at reducing the number of inflammatory acne lesions at three months.<ref name=Koo2014>{{cite journal | vauthors = Koo EB, Petersen TD, Kimball AB | title = Meta-analysis comparing efficacy of antibiotics versus oral contraceptives in acne vulgaris | journal = Journal of the American Academy of Dermatology | volume = 71 | issue = 3 | pages = 450–9 | date = September 2014 | pmid = 24880665 | doi = 10.1016/j.jaad.2014.03.051 | type = Systematic Review & Meta-Analysis }}</ref> However, the two therapies are approximately equal in efficacy at six months for decreasing the number of inflammatory, non-inflammatory, and total acne lesions.<ref name=Koo2014/> The authors of the analysis suggested that birth control pills may be a preferred first-line acne treatment, over oral antibiotics, in certain women due to similar efficacy at six months and a lack of associated antibiotic resistance.<ref name=Koo2014/> In contrast to combined birth control pills, [[progestogen-only birth control]] forms that contain androgenic progestins have been associated with worsened acne.<ref name="Barbieri2019"/>

[[Antiandrogen]]s such as cyproterone acetate and [[spironolactone]] can successfully treat acne, especially in women with signs of excessive androgen production, such as increased [[hirsutism|hairiness]] or skin production of sebum, or [[alopecia|scalp hair loss]].<ref name="Aslam2015"/><ref name=Kong2013/> Spironolactone is an effective treatment for acne in adult women.<ref name="pmid28155090" /><ref>{{cite journal |last1=Santer |first1=Miriam |last2=Lawrence |first2=Megan |last3=Renz |first3=Susanne |last4=Eminton |first4=Zina |last5=Stuart |first5=Beth |last6=Sach |first6=Tracey H |last7=Pyne |first7=Sarah |last8=Ridd |first8=Matthew J |last9=Francis |first9=Nick |last10=Soulsby |first10=Irene |last11=Thomas |first11=Karen |last12=Permyakova |first12=Natalia |last13=Little |first13=Paul |last14=Muller |first14=Ingrid |last15=Nuttall |first15=Jacqui |date=2023-05-16 |title=Effectiveness of spironolactone for women with acne vulgaris (SAFA) in England and Wales: pragmatic, multicentre, phase 3, double blind, randomised controlled trial |journal=The BMJ |volume=381|pages=e074349 |doi=10.1136/bmj-2022-074349 |pmid=37192767 |pmc=10543374 |s2cid=258717921 |issn=1756-1833|doi-access=free }}</ref> Unlike combined birth control pills, it is not approved by the United States [[Food and Drug Administration]] for this purpose.<ref name=Vary2015/><ref name=Yin2014/><ref name="pmid28155090">{{cite journal | vauthors = Layton AM, Eady EA, Whitehouse H, Del Rosso JQ, Fedorowicz Z, van Zuuren EJ | title = Oral Spironolactone for Acne Vulgaris in Adult Females: A Hybrid Systematic Review | journal = American Journal of Clinical Dermatology | volume = 18 | issue = 2 | pages = 169–191 | date = April 2017 | pmid = 28155090 | pmc = 5360829 | doi = 10.1007/s40257-016-0245-x }}</ref> Spironolactone is an [[aldosterone antagonist]] and is a useful acne treatment due to its ability to additionally block the [[androgen receptor]] at higher doses.<ref name=Yin2014/><ref name="Barbieri2019"/> Alone or in combination with a birth control pill, spironolactone has shown a 33 to 85% reduction in acne lesions in women.<ref name="pmid22994662" /> The effectiveness of spironolactone for acne appears to be dose-dependent.<ref name="pmid22994662" /> High-dose cyproterone acetate alone reportedly decreases acne symptoms in women by 75 to 90% within three months.<ref name="pmid25627824" /> It is usually combined with an estrogen to avoid [[menstrual irregularities]] and [[estrogen deficiency]].<ref name="pmid9856417">{{cite journal | vauthors = Diamanti-Kandarakis E | title = How actual is the treatment with antiandrogen alone in patients with polycystic ovary syndrome? | journal = Journal of Endocrinological Investigation | volume = 21 | issue = 9 | pages = 623–9 | date = October 1998 | pmid = 9856417 | doi = 10.1007/BF03350788 | s2cid = 46484837 }}</ref> The medication appears to be effective in the treatment of acne in males, with one study finding that a high dosage reduced inflammatory acne lesions by 73%.<ref name="WardBrogden1984">{{cite journal | vauthors = Ward A, Brogden RN, Heel RC, Speight TM, Avery GS | title = Isotretinoin. A review of its pharmacological properties and therapeutic efficacy in acne and other skin disorders | journal = Drugs | volume = 28 | issue = 1 | pages = 6–37 | date = July 1984 | pmid = 6235105 | doi = 10.2165/00003495-198428010-00002 }}</ref><ref name="Rasmusson1986">{{cite book |doi=10.1016/S0065-7743(08)61128-8 |title=Chapter 18. Chemical Control of Androgen Action |series=Annual Reports in Medicinal Chemistry |year=1986 |last1=Rasmusson |first1=Gary H. |volume=21 |pages=179–188 |isbn=9780120405213 }}</ref> However, spironolactone and cyproterone acetate's side effects in males, such as [[gynecomastia]], [[sexual dysfunction]], and decreased [[bone mineral density]], generally make their use for male acne impractical.<ref name="WardBrogden1984" /><ref name="Rasmusson1986" /><ref name="pmid19297634">{{cite journal | vauthors = Giltay EJ, Gooren LJ | title = Potential side effects of androgen deprivation treatment in sex offenders | journal = The Journal of the American Academy of Psychiatry and the Law | volume = 37 | issue = 1 | pages = 53–8 | date = 2009 | pmid = 19297634 }}</ref>

Pregnant and lactating women should not receive antiandrogens for their acne due to a possibility of [[congenital disorder|birth disorders]] such as [[hypospadias]] and [[Feminization (biology)|feminization]] of male babies.<ref name=Kong2013/> Women who are sexually active and who can or may become pregnant should use an effective method of contraception to prevent pregnancy while taking an antiandrogen.<ref name="pmid30312645" /> Antiandrogens are often combined with birth control pills for this reason, which can result in additive efficacy.<ref name=Yin2014 /><ref name="pmid25896771">{{cite journal | vauthors = Oudenhoven MD, Kinney MA, McShane DB, Burkhart CN, Morrell DS | title = Adverse effects of acne medications: recognition and management | journal = American Journal of Clinical Dermatology | volume = 16 | issue = 4 | pages = 231–242 | date = August 2015 | pmid = 25896771 | doi = 10.1007/s40257-015-0127-7 | s2cid = 37512606 }}</ref> The FDA added a [[Boxed warning|black-box warning]] to spironolactone about possible [[tumor]] risks based on [[preclinical research]] with very high doses (>100-fold clinical doses) and cautioned that unnecessary use of the medication should be avoided.<ref name="Zaenglein2016"/><ref name="Barbieri2019" /><ref>{{cite web|title=FDA. Prescribing Information|url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/012151s062lbl.pdf|access-date=7 June 2020|archive-date=24 August 2020|archive-url=https://web.archive.org/web/20200824235422/https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/012151s062lbl.pdf|url-status=live}}</ref> However, several large [[epidemiological study|epidemiological studies]] subsequently found no greater risk of tumors in association with spironolactone in humans.<ref name="Barbieri2019" /><ref name="pmid30467659">{{cite journal | vauthors = Rozner RN, Freites-Martinez A, Shapiro J, Geer EB, Goldfarb S, Lacouture ME | title = Safety of 5α-reductase inhibitors and spironolactone in breast cancer patients receiving endocrine therapies | journal = Breast Cancer Res. Treat. | volume = 174 | issue = 1 | pages = 15–26 | date = February 2019 | pmid = 30467659 | pmc = 6773272 | doi = 10.1007/s10549-018-4996-3 }}</ref><ref name="pmid28979664">{{cite journal | vauthors = Endly DC, Miller RA | title = Oily Skin: A review of Treatment Options | journal = J Clin Aesthet Dermatol | volume = 10 | issue = 8 | pages = 49–55 | date = August 2017 | pmid = 28979664 | pmc = 5605215 }}</ref><ref name="pmid32738426">{{cite journal | vauthors = Heymann WR | title = Spironolactone and breast cancer: Fear not! | journal = J. Am. Acad. Dermatol. | date = July 2020 | volume = 83 | issue = 4 | pages = 1008–1009 | pmid = 32738426 | doi = 10.1016/j.jaad.2020.07.104 | s2cid = 220924754 }}</ref> Conversely, strong associations of cyproterone acetate with certain [[brain tumor]]s have been discovered and its use has been restricted.<ref name="SenofontePallotti2020">{{cite journal |last1=Senofonte |first1=Giulia |last2=Pallotti |first2=Francesco |last3=Lombardo |first3=Francesco |title=Ciproterone acetato e meningiomi: lo stato dell'arte |trans-title=Cyproterone acetate and meningiomas: the state of the art |language=it |journal=L'Endocrinologo |date=June 2020 |volume=21 |issue=3 |pages=171–175 |doi=10.1007/s40619-020-00746-8 |doi-access=free |hdl=11573/1492686 |hdl-access=free }}</ref><ref name="pmid32419942">{{cite journal | vauthors = Kohl S | title = Council of Europe resolution to promote pharmaceutical care in Europe | journal = Eur J Hosp Pharm | volume = 27 | issue = 3 | pages = 184–188 | date = May 2020 | pmid = 32419942 | doi = 10.1136/ejhpharm-2020-002305 | pmc = 7223358 }}</ref><ref name="pmid33536184">{{cite journal | vauthors = Weill A, Nguyen P, Labidi M, Cadier B, Passeri T, Duranteau L, Bernat AL, Yoldjian I, Fontanel S, Froelich S, Coste J | title = Use of high dose cyproterone acetate and risk of intracranial meningioma in women: cohort study | journal = The BMJ | volume = 372 | pages = n37 | date = February 2021 | pmid = 33536184 | doi = 10.1136/bmj.n37 | doi-access = free }}</ref> The brain tumor risk with cyproterone acetate is due to its strong [[progestogen (medication)|progestogenic]] actions and is not related to antiandrogenic activity nor shared by other antiandrogens.<ref name="SenofontePallotti2020" /><ref name="pmid32705456">{{cite journal | vauthors = Apra C, Roblot P, Alkhayri A, Le Guérinel C, Polivka M, Chauvet D | title = Female gender and exogenous progesterone exposition as risk factors for spheno-orbital meningiomas | journal = J. Neurooncol. | date = July 2020 | volume = 149 | issue = 1 | pages = 95–101 | pmid = 32705456 | doi = 10.1007/s11060-020-03576-8 | s2cid = 220720801 | url = https://hal.sorbonne-universite.fr/hal-03270880/file/Apra%20et%20al.%20-%202020%20-%20Female%20gender%20and%20exogenous%20progesterone%20expositio.pdf | access-date = 18 August 2021 | archive-date = 4 September 2021 | archive-url = https://web.archive.org/web/20210904051802/https://hal.sorbonne-universite.fr/hal-03270880/file/Apra%20et%20al.%20-%202020%20-%20Female%20gender%20and%20exogenous%20progesterone%20expositio.pdf | url-status = live }}</ref><ref name="pmid33536184" />

[[Flutamide]], a pure [[receptor antagonist|antagonist]] of the androgen receptor, is effective in treating acne in women.<ref name="pmid25627824">{{cite journal | vauthors = Bettoli V, Zauli S, Virgili A | title = Is hormonal treatment still an option in acne today? | journal = The British Journal of Dermatology | volume = 172 | pages = 37–46 | date = July 2015 | issue = Suppl 1 | pmid = 25627824 | doi = 10.1111/bjd.13681 | s2cid = 35615492 | doi-access =  }}</ref><ref name="pmid25845307">{{cite journal | vauthors = Husein-ElAhmed H | title = Management of acne vulgaris with hormonal therapies in adult female patients | journal = Dermatologic Therapy | volume = 28 | issue = 3 | pages = 166–72 | year = 2015 | pmid = 25845307 | doi = 10.1111/dth.12231 | s2cid = 2628354 | doi-access = free }}</ref> It appears to reduce acne symptoms by 80 to 90% even at low doses, with several studies showing complete acne clearance.<ref name="pmid25627824" /><ref name="pmid28562419">{{cite journal | vauthors = Nguyen HL, Tollefson MM | title = Endocrine disorders and hormonal therapy for adolescent acne | journal = Current Opinion in Pediatrics | volume = 29 | issue = 4 | pages = 455–465 | date = August 2017 | pmid = 28562419 | doi = 10.1097/MOP.0000000000000515 | s2cid = 4640778 }}</ref><ref name="pmid10495361">{{cite journal | vauthors = Diamanti-Kandarakis E | title = Current aspects of antiandrogen therapy in women | journal = Current Pharmaceutical Design | volume = 5 | issue = 9 | pages = 707–23 | date = September 1999 | doi = 10.2174/1381612805666230111201150 | pmid = 10495361 | url = https://books.google.com/books?id=9rfNZL6oEO0C&pg=PA707 | access-date = 21 December 2018 | archive-url = https://web.archive.org/web/20200227012541/https://books.google.com/books?id=9rfNZL6oEO0C&pg=PA707 | archive-date = 27 February 2020 | url-status = live }}</ref> In one study, flutamide decreased acne scores by 80% within three months, whereas spironolactone decreased symptoms by only 40% in the same period.<ref name="pmid10495361" /><ref name="ShelleyShelley2001">{{cite book|first1=Walter Brown|last1=Shelley|first2=E. Dorinda|last2=Shelley|title=Advanced Dermatologic Therapy II|url=https://books.google.com/books?id=vuJsAAAAMAAJ|year=2001|publisher=W. B. Saunders|isbn=978-0-7216-8258-7|access-date=21 December 2018|archive-date=11 January 2023|archive-url=https://web.archive.org/web/20230111121854/https://books.google.com/books?id=vuJsAAAAMAAJ|url-status=live}}</ref><ref name="BalenFranks2010">{{cite book | first1 = Adam | last1 = Balen | first2 = Stephen | last2 = Franks | first3 = Roy | last3 = Homburg | first4 = Sean | last4 = Kehoe | title = Current Management of Polycystic Ovary Syndrome | url = https://books.google.com/books?id=0rtUBAAAQBAJ&pg=PA132 | date = October 2010 | publisher = Cambridge University Press | isbn = 978-1-906985-41-7 | pages = 132– | access-date = 21 December 2018 | archive-date = 11 January 2023 | archive-url = https://web.archive.org/web/20230111121859/https://books.google.com/books?id=0rtUBAAAQBAJ&pg=PA132 | url-status = live }}</ref> In a large long-term study, 97% of women reported satisfaction with the control of their acne with flutamide.<ref name="pmid28492054">{{cite journal | vauthors = Trivedi MK, Shinkai K, Murase JE | title = A Review of hormone-based therapies to treat adult acne vulgaris in women | journal = International Journal of Women's Dermatology | volume = 3 | issue = 1 | pages = 44–52 | date = March 2017 | pmid = 28492054 | pmc = 5419026 | doi = 10.1016/j.ijwd.2017.02.018 }}</ref> Although effective, flutamide has a risk of serious [[liver toxicity]], and cases of death in women taking even low doses of the medication to treat androgen-dependent skin and hair conditions have occurred.<ref name="pmid28379593">{{cite journal | vauthors = Giorgetti R, di Muzio M, Giorgetti A, Girolami D, Borgia L, Tagliabracci A | title = Flutamide-induced hepatotoxicity: ethical and scientific issues | journal = European Review for Medical and Pharmacological Sciences | volume = 21 | issue = 1 Suppl | pages = 69–77 | date = March 2017 | pmid = 28379593 }}</ref> As such, the use of flutamide for acne has become increasingly limited,<ref name="pmid28492054" /><ref name="YasaDural2016">{{cite journal |last1=Yasa |first1=Cenk |last2=Dural |first2=Özlem |last3=Bastu |first3=Ercan |last4=Uğurlucan |first4=Funda Güngör |title=Hirsutism, Acne, and Hair Loss: Management of Hyperandrogenic Cutaneous Manifestations of Polycystic Ovary Syndrome |journal=Gynecology Obstetrics & Reproductive Medicine |date=22 August 2017 |volume=23 |issue=2 |pages=110–119 |doi=10.21613/GORM.2016.613 |doi-access=free }}</ref><ref name="pmid28274354">{{cite journal | vauthors = Barros B, Thiboutot D | title = Hormonal therapies for acne | journal = Clinics in Dermatology | volume = 35 | issue = 2 | pages = 168–172 | date = 2017 | pmid = 28274354 | doi = 10.1016/j.clindermatol.2016.10.009 }}</ref> and it has been argued that continued use of flutamide for such purposes is unethical.<ref name="pmid28379593" /> [[Bicalutamide]], a pure androgen receptor antagonist with the same mechanism as flutamide and with comparable or superior antiandrogenic [[efficacy]] but with a far lower risk of liver toxicity, is an alternative option to flutamide in the treatment of androgen-dependent skin and hair conditions in women.<ref name="pmid30312645">{{cite journal | vauthors = Azarchi S, Bienenfeld A, Lo Sicco K, Marchbein S, Shapiro J, Nagler AR | title = Androgens in women: Hormone-modulating therapies for skin disease | journal = Journal of the American Academy of Dermatology | volume = 80 | issue = 6 | pages = 1509–1521 | date = June 2019 | pmid = 30312645 | doi = 10.1016/j.jaad.2018.08.061 | s2cid = 52973096 }}</ref><ref name="pmid8717470">{{cite journal | vauthors = Blackledge GR | title = Clinical progress with a new antiandrogen, Casodex (bicalutamide) | journal = European Urology | volume = 29 Suppl 2 | issue = 2 | pages = 96–104 | date = 1996 | pmid = 8717470 | doi = 10.1159/000473847 }}</ref><ref name="pmid14748655">{{cite journal | vauthors = Fradet Y | title = Bicalutamide (Casodex) in the treatment of prostate cancer | journal = Expert Review of Anticancer Therapy | volume = 4 | issue = 1 | pages = 37–48 | date = February 2004 | pmid = 14748655 | doi = 10.1586/14737140.4.1.37 | s2cid = 34153031 }}</ref><ref name="pmid27416311">{{cite journal | vauthors = Hassoun LA, Chahal DS, Sivamani RK, Larsen LN | title = The use of hormonal agents in the treatment of acne | journal = Seminars in Cutaneous Medicine and Surgery | volume = 35 | issue = 2 | pages = 68–73 | date = June 2016 | pmid = 27416311 | doi = 10.12788/j.sder.2016.027 | doi-broken-date = 21 December 2024 }}</ref>

[[Clascoterone]] is a [[topical administration|topical]] antiandrogen that has demonstrated effectiveness in the treatment of acne in both males and females and was approved for clinical use for this indication in August 2020.<ref name="Winlevi FDA label">{{cite web | url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/213433s000lbl.pdf | title=Winlevi (clascoterone) cream, for topical use | publisher=Cassiopea | access-date=9 September 2020 | archive-date=18 September 2020 | archive-url=https://web.archive.org/web/20200918114726/https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/213433s000lbl.pdf | url-status=live }}</ref><ref name="pmid30466681">{{cite journal | vauthors = Marson JW, Baldwin HE | title = New Concepts, Concerns, and Creations in Acne | journal = Dermatologic Clinics | volume = 37 | issue = 1 | pages = 1–9 | date = January 2019 | pmid = 30466681 | doi = 10.1016/j.det.2018.07.002 | s2cid = 53718051 | type = Review }}</ref><ref name="Timmins2018">{{cite journal | title = Industry update: the latest developments in the field of therapeutic delivery, July 2018 | journal = Therapeutic Delivery | volume = 9 | issue = 11 | pages = 797–809 | year = 2018 | doi = 10.4155/tde-2018-0055 | type = Review | last1 = Timmins | first1 = Peter| doi-access = free }}</ref><ref name="pmid29594974">{{cite journal | vauthors = Trivedi MK, Bosanac SS, Sivamani RK, Larsen LN | title = Emerging Therapies for Acne Vulgaris | journal = American Journal of Clinical Dermatology | volume = 19 | issue = 4 | pages = 505–516 | date = August 2018 | pmid = 29594974 | doi = 10.1007/s40257-018-0345-x | s2cid = 4398912 | type = Review }}</ref><ref name="pmid29872679">{{cite journal | vauthors = Tan AU, Schlosser BJ, Paller AS | title = A review of diagnosis and treatment of acne in adult female patients | journal = International Journal of Women's Dermatology | volume = 4 | issue = 2 | pages = 56–71 | date = June 2018 | pmid = 29872679 | pmc = 5986265 | doi = 10.1016/j.ijwd.2017.10.006 | type = Review }}</ref> It has shown no systemic absorption or associated antiandrogenic side effects.<ref name="pmid29594974" /><ref name="pmid29872679" /><ref name="pmid25474485">{{cite journal | vauthors = Aslam I, Fleischer A, Feldman S | title = Emerging drugs for the treatment of acne | journal = Expert Opinion on Emerging Drugs | volume = 20 | issue = 1 | pages = 91–101 | date = March 2015 | pmid = 25474485 | doi = 10.1517/14728214.2015.990373 | s2cid = 12685388 }}</ref> In a small direct head-to-head comparison, clascoterone showed greater effectiveness than topical isotretinoin.<ref name="pmid29594974" /><ref name="pmid29872679" /><ref name="pmid25474485" /> [[5α-Reductase inhibitor]]s such as [[finasteride]] and [[dutasteride]] may be useful for the treatment of acne in both males and females but have not been adequately evaluated for this purpose.<ref name=Vary2015/><ref name="pmid23377402">{{cite journal | vauthors = Azzouni F, Zeitouni N, Mohler J | url = https://jddonline.com/articles/dermatology/S1545961613E0030X | title = Role of 5α-reductase inhibitors in androgen-stimulated skin disorders | journal = Journal of Drugs in Dermatology | volume = 12 | issue = 2 | pages = e30-5 | date = February 2013 | pmid = 23377402 | access-date = 31 August 2020 | archive-date = 9 August 2020 | archive-url = https://web.archive.org/web/20200809085939/https://jddonline.com/articles/dermatology/S1545961613E0030X | url-status = live }}</ref><ref name="Danby2015">{{cite book|first=F. William|last=Danby|title=Acne: Causes and Practical Management|url=https://books.google.com/books?id=Z1yFBQAAQBAJ&pg=PA147|date=27 January 2015|publisher=John Wiley & Sons|isbn=978-1-118-23277-4|pages=147–|access-date=21 December 2018|archive-date=10 January 2023|archive-url=https://web.archive.org/web/20230110031704/https://books.google.com/books?id=Z1yFBQAAQBAJ&pg=PA147|url-status=live}}</ref><ref name="pmid23431485">{{cite journal | vauthors = Marchetti PM, Barth JH | title = Clinical biochemistry of dihydrotestosterone | journal = Annals of Clinical Biochemistry | volume = 50 | issue = Pt 2 | pages = 95–107 | date = March 2013 | pmid = 23431485 | doi = 10.1258/acb.2012.012159 | s2cid = 8325257 | doi-access = free }}</ref> Moreover, 5α-reductase inhibitors have a strong potential for producing birth defects in male babies and this limits their use in women.<ref name=Vary2015/><ref name="Danby2015" /> However, 5α-reductase inhibitors are frequently used to treat [[hirsutism|excessive facial/body hair]] in women and can be combined with birth control pills to prevent pregnancy.<ref name="pmid23377402" /> There is no evidence as of 2010 to support the use of [[cimetidine]] or [[ketoconazole]] in the treatment of acne.<ref name="pmid20082945">{{cite journal | vauthors = Katsambas AD, Dessinioti C | title = Hormonal therapy for acne: why not as first line therapy? facts and controversies | journal = Clinics in Dermatology | volume = 28 | issue = 1 | pages = 17–23 | date = 2010 | pmid = 20082945 | doi = 10.1016/j.clindermatol.2009.03.006 }}</ref>

Hormonal treatments for acne such as combined birth control pills and antiandrogens may be considered first-line therapy for acne under many circumstances, including desired contraception, known or suspected hyperandrogenism, acne during adulthood, acne that flares premenstrually, and when symptoms of significant sebum production (seborrhea) are co-present.<ref name="pmid20082945" /> Hormone therapy is effective for acne both in women with hyperandrogenism and in women with normal androgen levels.<ref name="pmid20082945" />