Cyproterone acetate in acne vulgaris in females: clinico therapeutic and biochemical studies

ABSTRACT

A generally accepted, single treatment modality for acne vulgaris is still a puzzle. An open study is carried out on 50 female patients to assess the clinical efficacy of an antiandrogen on acne lesions as well as on comedonal structures. Each female patient received one pill every day starting from the 5th day of the menstrual period and for successive 21 days followed by 7 days pills-free period. Pills contained 2 mg cyproterone acetate combined with 50 Ug ethinyl-oestradiol per pill, this cyclic therapy is repeated for 4 months. Before and after treatment, all patients were subjected to clinical evaluation by counting the number of lesions and by general patient and observer assessment. 20 of the cases were selected with plenty of comedones. Comedonal contents were collected to estimate the level of triglycerides, free fatty acids and cholesterol in their material. It was found that the antiandrogen [cyproterone acetate] was greatly effective in the inflammatory types of acne vulgaris lesions [papules, pustules, cysts and nodules] in all cases. Comedones also showed a good reduction in their number, however, cysts and nodules showed marked reduction in their inflammatory nature, without affection of their number. The levels of triglycerides, free fatty acids and cholesterol before treatment were 0.204 +/- 0.1, 0.257 +/- 0.1 and 0.456 +/- 0.14 mmol/gm comedones respectively which can be considered as their values in acne patients. These values were significantly reduced after treatment only in triglycerides and free fatty acids while cholesterol showed a nonsignificant reduction. Side-effects of the drug used were minimal and negligible if compared to its satisfactory clinical effects. We can advice the use of the antiandrogen "Cyproterone acetate" combined with ethinyloestradiol especiall;y in cases with inflammatory lesions of acne in females, especially married ones wishing to use a contraceptive measure: