GIna asked
My doctor said she is going to prescribe a birth control to help with my acne. Can birth control do that and is there one better than another?
Answer
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Acne is a lot like mosquitoes. It seems to only exist to be really
annoying and capable of producing red bumps all over our bodies. Acne is no fun
to deal with at any age, but there are effective ways to tackle it, and birth
control is high on the list. For the purposes of this response, I’m going to
use the term oral contraceptive (OC) to refer to any birth control pill you
take by mouth.
What Causes Acne?
Humans are mammals, and one major characteristic of mammals is having hair all over the body. Every hair is made in its own hair follicle, and comes out of the skin via a pore. Each pore also has a gland that produces oil, called sebum. In the areas of your body where you have very light or no hair, you can often see these pores (face, for example).
Acne happens when the pores get clogged by excess oil, dirt, dead skin cells, and lots of other crud our skin gets exposed to. This causes inflammation and blemishes. Worse, the bacterium P. acnes that lives on the surface of everyone’s skin feeds on the oil it makes, producing waste chemicals that are very irritating to skin cells. This irritation, plus pressure from touching your face, clothing, or masks, can make acne a lot worse.Treating Acne
We can treat acne in a few ways based on the above causes:1) Removing oil and dirt on your skin that could clog your pores (generally by washing).
2) Killing the bacteria that are making things worse. 3) Avoiding touching your face or wearing tight clothing or accessories. 4) Reducing the amount of oil your skin produces to begin with. This last one is where oral contraceptives come into play.Oil and hair production are controlled by sex hormones called androgens (“male sex hormones”). The androgens are opposed in effects by estrogens (“female sex hormones”). It might surprise you to learn that both sexes produce both types of hormones, just at different levels and in different ways.
In females, hormonal levels change often and by quite a lot, but in a predictable pattern that controls the menstrual cycle. About mid-cycle, estrogen spikes, then falls and levels out. About a week before your period, it falls to its lowest levels and stays there until menstruation is complete; this is the time when many women experience an increase in acne breakouts. This is likely because there’s much less estrogen to oppose the effects of androgens. So, the androgens get to do their thing and increase oil production, and you get an increase in acne, and probably stress as well.
One Pill, Two Pill, Red Pill, Blue Pill?
Oral contraceptives come in a couple flavors. Combined OCs contain an estrogen (ethinyl estradiol is the only one you’ll see) and a progestin, another type of sex hormone. There are also progestin-only OCs. While many OCs are similarly effective in treating acne, it’s clear that estrogen is a required ingredient. Progestin-only OCs just aggravate acne caused by premenstrual hormone changes.
A combined OC is frequently the top choice when first starting on the pill. Since they all contain the same kind of estrogen, the choice comes down to the other component, the progestin. Right now, there are 3 products that have an FDA approval for treating mild-to-moderate acne: Ortho-Tri-Cyclen, Estrostep, and YAZ. They each contain a different progestin, plus ethinyl estradiol.
It appears that the progestin in YAZ, drosperinone, has extra antiandrogen effects that make it more effective against acne than other progestins. If you have particularly bad acne breakouts before and during your period, this may be a good first choice to talk about with your doctor.
Attacking From All Angles
Keep in mind that while many women see an improvement in acne symptoms after starting the pill, the pill only alters the amount of oil produced by your skin. Getting rid of acne often requires a combination approach to target other acne causes. The most important of these is a daily skin care regimen. This isn’t just limited to washing your face daily, and since this goes beyond the scope of your question, I’d like to highly recommend acne.org as a resource for learning how to reduce acne and keep skin healthy. They also have a very high-quality, affordable skin care regimen available, but the main purpose of the site is for information.
References
Women and Acne. https://www.acne.org/women-and-acne.html Accessed December 5, 2017
Acne in Females. https://www.acne.org/female.html Accessed December 5, 2017
Conflict of Interest/Financial Disclosure: Dr. Higgins has no promotional or financial relationships with any of the products, companies, or website mentioned in this article.
