Q&A: Taking Birth Control Pills to Treat Acne

Of Pimples and the Pill

Question: I am 27 and have had acne since my teens. I’ve been told that birth control pills can improve severe skin conditions, so I want to ask my family doctor to prescribe some. How does medication work for acne, and how long should I take the pills? I am married and would like to try for a baby in the next couple of years.

Answer: You may have adult female acne. This refers to acne in women over the age of 25. This condition may either be from pre-existing adolescent acne or new-onset acne in adulthood. Adult acne can persist even into the 30s and 40s. In patients with adult female acne, delayed menstrual cycle, signs of androgen (male hormone) excess such as excessive hair, patterned hair loss, acanthosis nigricans (dark and rough pigmentation on the neck and/or underarms), should be evaluated for polycystic ovary syndrome and hormonal imbalances.

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Not all patients with adult female acne require treatment with oral contraceptives. For mild cases, applied acne medications may be enough. Examples of topical therapy are benzoyl peroxide, retinoids or antibiotics. More severe cases may be treated with oral antibiotics, contraceptive pills, isotretinoin or even off-label spironolactone (an anti-androgen). Oral contraceptive pills (OCPs) may be helpful in adult female acne, particularly in women with polycystic ovary syndrome or signs of excess androgen. OCPs work by regulating hormonal levels. Consult your doctor about your acne as conditions such as rosacea and hidradenitis suppurativa (a long-term skin condition that features small, painful lumps under the skin) can be mistaken for acne.

Contraceptives Can Worsen Skin Conditions

Certain oral contraceptives such as the mini-pill or progesterone-only contraceptive can worsen acne. Combination oral contraceptives are the preferred OCP for acne but note that OCPs may not be suitable for all women. Those who smoke or have a history of clotting disorders are at increased risk of deep venous thrombosis and stroke if they take these. The ability to conceive is not affected in women who have used oral contraceptives. Finally, for acne to improve on oral contraceptives, the drug may need to be taken for several weeks to months.

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