Acne vulgaris in female patients represents a specific clinical scenario where sex-based biological factors directly inform the available evidence-based treatment options.
This protocol applies to female patients presenting with acne vulgaris. Certain therapeutic options in this population are supported by dedicated evidence and regulatory approvals in females. Eligibility for these options is not restricted to patients with jawline acne, premenstrual flares, hirsutism, or hyperandrogenism — broader patient profiles qualify.
For female patients, the evidence base supports the use of hormonal therapies — including certain oral contraceptive formulations — which may be used alone or combined with other acne treatments.
Treatment targets include measurable acne improvement assessed at defined timepoints that differ by therapeutic agent. Response timelines and the outcome measures used to define success are specified in the full protocol.
DOI: 10.1016/j.jaad.2023.12.017
Four COCs are FDA-approved for treatment of acne in women who desire oral contraception, including norgestimate/EE, norethindrone acetate/EE/ferrous fumarate, drospirenone/EE, and drospirenone/EE/levomefolate.
COC for acne treatment is not limited to patients with acne affecting the jawline or with premenstrual flares, hirsutism, or hyperandrogenism.
We conditionally recommend COCs for acne treatment based on moderate certainty evidence from 10 studies and variability in patient values and preferences related to contraception.
We conditionally recommend spironolactone for acne treatment based on moderate certainty evidence from 8 studies.
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