New Treatments for Adult Female Acne.
M Zalve-Vicedo, T Montero-Vilchez, A Buendía-Eisman et al.
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In 30 seconds
This systematic review assessed the effectiveness and safety of antiandrogenic treatments for acne in adult women, drawing on human epidemiological studies published in the preceding 10 years. Thirteen studies involving 1335 patients evaluated spironolactone or metformin; none evaluated bicalutamide. Both studied drugs were reported to reduce acne lesions, with generally good safety and tolerability. Menstrual irregularities were the most frequent adverse effects with spironolactone, while metformin was associated most often with gastrointestinal discomfort. The authors conclude that these treatments are promising but require more controlled, randomised comparisons.
Key findings
- Thirteen included studies evaluated 1335 patients: 4 (30.8%) addressed spironolactone and 9 (69.2%) metformin.
- Both spironolactone and metformin showed reductions in acne lesions and generally good safety and tolerability.
- Menstrual irregularities were the most frequent adverse effects with spironolactone; gastrointestinal discomfort was most frequent with metformin.
- No studies evaluating bicalutamide for acne met the review criteria.
Why it matters
The review summarises evidence for two systemic options that may be relevant when adult female acne occurs alongside androgen-related abnormalities or hyperandrogenism. It also highlights differing adverse-effect profiles and reports metabolic improvements with metformin, potentially relevant to acne associated with polycystic ovary syndrome. The evidence base remains insufficient for firm comparative conclusions.
What to keep in mind
The review included varied epidemiological designs, and the authors state that more controlled and randomised studies are needed to assess efficacy and tolerability with stronger evidence.