Effectiveness of Hormone Based Therapies (Spironolactone and Combined Oral Contraceptives in the Management of Acne Vulgaris in Women: A Systematic review and meta-analysis

Abstract

Background: Acne vulgaris (AV) is a chronic inflammatory disease of the pilosebaceous follicular unit that often occurs. Acne is a skin disorder that is not life-threatening but is mostly complained of because it is aesthetically disruptive, which can cause significant psychological problems for sufferers. The management of acne vulgaris in female patients has its challenges. There are many histories of failed therapy using conventional therapy, such as with antibiotics or isotretinoin, and female patients have a predisposition to the condition of androgen excess. Also, the increasing awareness about limiting the use of antibiotics to prevent resistance in dermatological cases, including acne vulgaris, encourages other treatment options in the female patient population, one of which is hormone-based therapy. A systematic review and meta-analysis were performed of randomized clinical trials assessing the effects of Hormone Based Therapies (Spironolactone and Combined Oral Contraceptives) in the management of Acne Vulgaris in Women. Methods: Medline Pubmed, Scopus, Cochrane Library, the reference list, conference proceedings, researchers in the field of eligible studies were searched. Ten studies (n=1906 sub-jects) were included in qualitative analysis, of which two studies (n=1842 subjects) were included in the meta-analysis. The age of the participant was greater than 14 years old. Intervention using combined oral contraceptives (n=8) or oral spironolactone (n=2). Duration of intervention (minimum six months for COC and three months for SL) and out-comes of mean difference number of acne vulgaris lesions before and after treatment. Results: Pooling of data using random-effects model found a significant difference in the mean difference in the number of lesions after treatment in the group receiving hormone-based therapy (spironolactone and combined oral contraceptives) and those receiving control therapy (p = 0.005). The overall mean difference was -0.890 ± 0.316. A negative value indicating the number of lesions after hormone-based therapy (spironolactone and combined oral contraceptives) was significantly lower than those receiving control therapy (p = 0.005). Conclusion: From the results of the systematic review and meta-analysis conducted, it can be concluded that in the group given hormone-based therapy (spironolactone and Combined Oral Contraceptives), there was a decrease in the total number of acne vulgaris lesions compared to before treatment, and the mean difference in the number of lesions was significantly lower after getting hormone-based therapy (spironolactone and combined oral contraceptives) compared with controls.