Smith Courtney A, Gosnell Emily, Karatas Turkan Banu, Deitelzweig Chelsea, Collins Elizabeth M B, Yeung Howa
Department of Dermatology, Emory University School of Medicine, 1525 Clifton Road NE, Atlanta, GA, 30322, USA.
Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA.
Dermatol Ther (Heidelb). 2025 Jan;15(1):45-59. doi: 10.1007/s13555-024-01324-8. Epub 2025 Jan 3.
Acne impairs quality of life, often leads to permanent scars, and causes psychological distress. This review aims to update dermatologists on the Federal Drug Administration (FDA)-approved and off-label use of combined oral contraceptives (COC), clascoterone, spironolactone, and emerging hormonal therapies for acne treatment.
We reviewed current literature on hormonal acne treatments and discussed common patient concerns, barriers to care, and individualized care needs.
Different brands and dosings of COC have generally similar efficacy in treating acne. Dermatologists should discuss contraceptive options and provide individualized shared decision-making with patients based on patient preferences, contraceptive needs, comorbidity profile, access, and cost. Spironolactone is an effective acne treatment with clinical trial data to support its use as a first-line acne treatment for women with acne. Potassium monitoring is of low value for patients on spironolactone unless patients have specific risk factors for hyperkalemia. Clascoterone is a safe and effective topical anti-androgen for the treatment of acne in men and women with limited systemic effects on reproductive hormones.
Hormonal therapies are essential strategies to treat acne. Clinicians should expand the use of existing and emerging hormone therapy as part of their acne treatment strategies.
痤疮会损害生活质量，常导致永久性疤痕，并引起心理困扰。本综述旨在向皮肤科医生介绍美国食品药品监督管理局（FDA）批准的以及超说明书使用的复方口服避孕药（COC）、克拉睾酮、螺内酯和新兴激素疗法在痤疮治疗中的应用。
我们回顾了有关激素性痤疮治疗的当前文献，并讨论了常见的患者关注点、护理障碍和个性化护理需求。
不同品牌和剂量的COC在治疗痤疮方面通常具有相似的疗效。皮肤科医生应讨论避孕选择，并根据患者偏好、避孕需求、合并症情况、可及性和成本，为患者提供个性化的共同决策。螺内酯是一种有效的痤疮治疗药物，有临床试验数据支持其作为女性痤疮的一线治疗药物使用。对于服用螺内酯的患者，除非患者有高钾血症的特定危险因素，否则监测血钾价值不大。克拉睾酮是一种安全有效的外用抗雄激素药物，可用于治疗痤疮，对生殖激素的全身影响有限。
激素疗法是治疗痤疮的重要策略。临床医生应扩大现有和新兴激素疗法的使用，将其作为痤疮治疗策略的一部分。
