Oral Contraception and Skin

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Hans van der Slikke, MD: "It's September of 2001 and we're in Paris at the 2nd Controversies in Gynecology and Obstetrics Conference. Next to me is Professor Beate Tebbe and she's a dermatologist from the Free University of Berlin. Welcome, Professor Tebbe."

Beate Tebbe, MD: "Hello."

Hans van der Slikke, MD: "You delivered a talk about acne and seborrhea and focused especially on women, of course, because this is a gynecology conference. What exactly is the pathophysiology of acne?"

Beate Tebbe, MD: "There are several pathophysiological factors involved in acne disease and a very important one is the sebum secretion rate. We know that the sebum secretion rate increases in acne and correlates well with the severity of the disease but besides this other factors are also involved. Most believe that acne disease starts by follicular hyperkeratosis which leads to bacterial overgrowth in the sebaceous follicle."

Hans van der Slikke, MD: "Nobody likes to have acne, how could you influence it?"

Beate Tebbe, MD: "This depends on the stage of the disease. There are several variances of acne and the mildest variant is acne comedo, which is characterized by oily plugging in the follicle, and for this local treatment is very effective, and the local treatment that I prefer is retinoids or antibacterial substances. In the most severe acne variance like acne papula pustulosis where there's pimples or acne conglobata, treatment can be necessary. In Germany, a first choice is the use of an oral tetracycline, and if this antibiotic doesn't work then we choose the systemic retinoids. But the use of systemic retinoids is limited by the fact of terato-genicity and that's why it's a good choice for females to use oral contraceptives. We have several options in this field, and in Germany very frequently these antiandrogens have cyproterone acetate used. That means that the oral contraceptives competitively inhibits the binding of androgens to the androgen receptor but also other oral contraceptives with estrogens are known to influence the hormone metabolism very well and decrease the sebum secretion rate and influence acne disease."

Hans van der Slikke, MD: "You say if you use some of these medications it can be dangerous to get pregnant so why not combine it with an oral contraceptive?"

Beate Tebbe, MD: "Yes, it's absolutely necessary if you prescribe systemic retinoids to combine it with an oral contraceptive and even after discontinuation of the retinoids you should go on with contraceptives for one year. This necessity also has positive aspects because by using the oral contraceptives you also influence the skin disorder."

Hans van der Slikke, MD: "How does this work exactly and on which level? Is it in the receptor of the skin or more systemically?"

Beate Tebbe, MD: "Fifty-percent of the testosterone metabolism is in the skin and that means hormones which influence the metabolism of testosterone work in the skin or in the peripheral in the metabolism of the liver. Antiandrogens can competitively inhibit the binding of androgens to the androgen receptor in the sebaceous follicle and other contraceptives like estrogens increase the sex binding hormone SHBG, and by this they lower the level of peripheral free testosterone and that is the reason why the sebum secretion rate decreases."

Hans van der Slikke, MD: "I'm glad you gave us a good overview about this condition and taught us that as gynecologists we sometimes tend to forget the biggest organ of our body. Thank you very much for this interview."