Q: I have considered taking some of the new hormonal based pills to control my acne but am concerned about possible side effects. Are they safe to use? I believe these medications are similar to taking an oral contraceptive and can be used for both purposes.
A: There is some controversy regarding the use of these hormonal based medications for the treatment of acne. The brand names are Diane 35 and Estelle 35. They are so named because they contain 35 micrograms of the female hormone ethinylestodiol, which is similar to low dose oral contraceptives.
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However, they also contain an anti-male hormone known as cyproterone acetate. This drug has been used in the past to try to treat male sex offenders by lowering their sex drive. Women who suffer from oily skin and severe acne are thought to be producing too much male hormone or testosterone.
Many doctors now believe that the use of Diane 35 and similar medications should be confined to such female conditions as polycystic ovary syndrome, abnormal hairiness or hair falling out due to excess male hormones.
It should only be used for the treatment of severe acne. The reason for this caution is that a recent case study has found that a woman would have four times the risk of developing dangerous and potentially fatal blood clots compared with a higher dose oral contraceptive.
However, to put this in perspective, there is a much greater risk of developing blood clots during pregnancy, which is estimated to be 60 cases per 100,000 women.
Gynecologists in Canada continue to recommend these medications for the treatment of acne as well as for contraceptive use, but the Medicines Adverse Reactions Committee of New Zealand has issued an advisory to physicians cautioning them to confine the drug to treating only severe cases of acne and the medical conditions mentioned above.
To determine if your acne is bad enough to warrant this treatment, you should be assessed by a doctor and get a second opinion from a dermatologist.
You should definitely not take Diane 35 if you have ever had a circulatory problem or blood clots, diabetes with damage to the blood vessels, severe liver disease, breast cancer or other cancers of the female organs or are pregnant or planning to become pregnant.
Other conditions that may not prevent you from taking this drug but which should be carefully monitored by a doctor include smoking, high blood pressure, varicose veins, epilepsy, liver or gallbladder disease, Crohn’s disease, being overweight, having a heart valve or rhythm disorder, susceptibility to migraines, or a family history of thrombosis, heart attack, stroke or breast cancer.
Clare Rowson is a medical doctor with a practice near Belleville, Ont. Her columns are intended for general information only. Individuals are encouraged to also seek the advice of their own doctor regarding medical questions and treatments.
