Combined oral contraceptive pill

If there is another indication for using a combined oral contraceptive pill (COCP), or if acne may be related to hormonal changes (eg menstrual cycles), a COCP can be an alternative to oral antibiotics in adolescent and adult females with moderate to severe acne.

A COCP that contains a progestogen that is antiandrogenic (eg cyproterone, dienogest, drospirenone) or less androgenic than levonorgestrel (eg desogestrel, gestodene, norethisterone) might theoretically be more beneficial for acne, but there is insufficient evidence to indicate superiority of one COCP formulation over another for acne; see Contraception in individuals with acne in the Sexual and Reproductive Health guidelines.

If a patient already taking a COCP develops acne, consider switching to a COCP containing a progestogen that is antiandrogenic (eg cyproterone, dienogest, drospirenone) or less androgenic than levonorgestrel (eg desogestrel, gestodene, norethisterone).

For formulations of COCPs available in Australia, see Formulations of combined hormonal contraception available in Australia in the Sexual and Reproductive Health guidelines.

Often the benefit of a COCP is slow and may not be apparent for 3 months, so a 6-month trial is recommended. COCPs can be used long term.

If the response to COCP monotherapy is insufficient after 6 months, add an oral antibiotic (if not trialled previously), or add or change to spironolactone. Alternatively, refer to a dermatologist for consideration of oral isotretinoin.