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ORIGINAL CONTRIBUTIONS
Year : 1990  |  Volume : 56  |  Issue : 1  |  Page : 34-36

Treatment of acne vulgaris with anti androgens




Correspondence Address:
Neena Vaswani


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Source of Support: None, Conflict of Interest: None


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  Abstract 

This study was conducted to compare the relative efficacy of spironolactone and cimetidine in moderately severe acne vulgaris. Fifteen women were treated with spironolactone (100 mg daily) given cyclically, while 14 women were given cimetidine (1400 mg daily) cyclically. The response was evaluated at 12 weeks. Spironolactone produced a good to excellent response in 11 (73. 3%) acne patients while with cimetidine 6 (42.8%) patients showed a good to excellent response. The mean reduction of the non-inflammatory and inflammatory lesion count was 29. 3 + 3. 6 and 9. 7 + 1. 3 respectively with spironolactone and 18.6 + 5.8 and 6.4 + 2.1 respectively with cimetidine. The response of acne vulgaris to spironolactone was superior to that of cimetidine and this difference was statistically significant (p<.05). The side effects were minimal and did not necessitate withdrawal of treatment.


Keywords: Acne vulgaris, Spironolactone, Cimetidine


How to cite this article:
Vaswani N, Pandhi R K. Treatment of acne vulgaris with anti androgens. Indian J Dermatol Venereol Leprol 1990;56:34-6

How to cite this URL:
Vaswani N, Pandhi R K. Treatment of acne vulgaris with anti androgens. Indian J Dermatol Venereol Leprol [serial online] 1990 [cited 2019 Jun 25];56:34-6. Available from: http://www.ijdvl.com/text.asp?1990/56/1/34/3476


Androgens are known to stimulate sebaceous gland activity and the appearance of acne is partly linked to the rising levels of androgens that occur at puberty. It is thus logical to use anti-androgens for the treatment of acne.

Cyproterone acetate has been successfully used for the treatment of acne and hirsutism.[1],[2] Spironolactone[3] and cimetidine[4] also have anti­androgenic properties and have been success­fully used for the treatment of hirsutism.[5] Recently, spironolactone has also been found useful for the treatment of acne both syste­mically[6],[7] and topically.[8] Buckshee and Ahuja[9] observed that cimetidine reduced acne and facial oiliness, but the response was not graded. To the best of our knowledge, the relative efficacy of spironolactone and cimetidine has not been compared in acne.


  Materials and Methods Top


Thirty two women (aged 12-25 years) with moderately severe acne were taken up for the study. Moderately severe acne was defined as presence of 5-15 inflammatory lesions and/or more than 50 non-inflammatory lesions. Patients who had hirsutism and women who were either pregnant or using oral contraceptives were not included. Patients who were taking oral anti­biotic therapy were included only one month after discontinuing the antibiotics.

Patients were randomly allocated to one of the two treatment schedules : (a) Spironolac­tone, 100 mg a day or (b) cimetidine, 1400 mg a day given from the fifth to twenty fifth day of the menstrual cycle in patients with regular cycles and for twenty one days with a seven day gap in patients with irregular cycles.

No local therapy was prescribed with either of the two schedules. The blood pressure and the serum electrolyte (sodium and potassium) levels were regularly monitored.

The efficacy of the drugs was evaluated at 4 weekly intervals by counting the lesions by the same observer. The criterion for effectiveness of the treatment was significant reduction in the number of non-inflammatory and inflamma­tory lesions on the face at the end of 12 weeks. The improvement was graded as follows : (1) excellent, when there was more than 75% reduction in the lesion count, (2) good, when there was 50-75% reduction in the lesion count, (3) fair, when there was 25-50% reduction in the lesion count, (4) poor, when there was less than 25% reduction in the lesion count.

In addition, the mean reduction in non­inflammatory and inflammatory lesions was calculated for each of the two therapeutic groups. The response was statistically evaluated using Student's t-test. A p value of<0.05 was considered significant.


  Results Top


Twenty nine of the 32 patients could be followed-up for the stipulated 12 weeks. The clinical response to spironolactone and cime­tidine is depicted in [Table - 1][Table - 2]. The response to spironolactone was superior to that of cimetidine and this difference was statistically significant (p<0.05).

Side effects were observed in 3(20%) patients on spironolactone and in 3 (21.3%) patients on cimetidine. Menstrual irregularities were seen in 2 patients each in both the therapeutic groups.

Giddiness, lethargy, lack of concentration, mild headache nausea and vomiting were the other side effects. These side effects did not necessi­tate withdrawal of treatment and generally became milder as the treatment was continued.


  Comments Top


Anti-androgens are known to have anti­acne effects but these cannot be used in men because of the side effects like gynaecomastia and impotence.[6]

Spironolactone, an aldosterone antagonist inhibits androgenic action of testosterone by binding at the sites of the cytosol receptors in the target cells.[3] It also increases the apparent level of free estradiol while decreasing the apparent level of free testosterone.[10] Cimeti­dine, an H 2 receptor blocker, decreases the binding of dihydrotestosterone to the androgen receptors.[4]

In the present study, spironolactone produced a good to excellent improvement in 11 (73.3%) acne patients, while 2 (13.3%) patients showed a poor response. The mean reduction of the non-inflammatory lesions was 29.3 + 3.6, and of the inflammatory lesions 9.7 + 1.3. These results are similar to those of Muhlemann et al. They had used a higher dose (200 mg) of spiro­nolactone in 21 women with acne vulgaris for 3 months and noted a significant improvement in 75% of their patients. Goodfellow et al[6] found spironolactone effective in 16 patients with severe acne in doses of 50-200 mg daily; the clinical response was found to be dose depen­dent, with the maximum benefit in a dose of 150-200 mg. They also found a dose dependent reduction in the excretion rate of sebum in these patients.

The side effects noted by us are similar to those observed by Muhlemann et al.[7] Good­fellow et al,[6] however, noted a higher incidence of side effects, because they had included male patients in their study.

Buckshee and Ahujas used cimetidine for the treatment of hirsutism and noticed a concomitant improvement in acne in their subjects. They however did not quantify the response. We found good to excellent response to cimetidine in 6 (42.8%) patients of acne while 5 (35.7%) showed a poor response. The lesion count showed a mean reduction of 18.6 + 5.8 and 6.4 + 2.1 for the non-inflamma­tory and inflammatory lesions respectively.

The incidence of side-effects of cimetidine in our patients and the type of untoward effects are similar to those observed by Buckshee and Ahuja.[9]

A better response with spironolactone than cimetidine, seems logical, because in vitro studies have shown that spironolactone is a more potent androgen receptor blocker than both cyproterone acetate and cimetidine.[11] The therapeutic effect of these two anti-androgens has previously not been compa red in acne.

 
  References Top

1.Hammerstein J, Mechies J, Leo R et al Use of cyproterone acetate in the treatment of acne, hirsutism and virilism, J Steroid Biochem, 1975; 6 : 827-836.  Back to cited text no. 1    
2.Ekoe J, Burckhardt P and Ruedi S : Treatment of hirsutism, acne and alopecia with cyproterone .acetate, Dennatologica, 1980; 160 : 398-404.  Back to cited text no. 2    
3.Cumming DG, Yaug JC, Rebar RW et al : Treat­ment of hirsutism with spironolactone, J Amer Med Assoc, 1982; 247 : 1295-1298.  Back to cited text no. 3    
4.Funder JW and Mercer JR : Cimetidine, a hista­mine H2 receptor antagonist occupies androgen receptors, J Clin Endocrinol Metabol, 1979; 48 189-191.  Back to cited text no. 4    
5.Buckshee K, Kaur J, Agarwal N et al : Therapeutic evaluation of spironolactone and cimetidine in hirsutism, J Obstet Gyraecol, 1987; 27 : 423-426.  Back to cited text no. 5    
6.Goodfellow A, Alaghband-Zadeh J, Carter G et al : Oral spironolactone improves acne vulgaris and reduces sebum excretion, Brit J Dermatol, 1984; 111 : 209-214.  Back to cited text no. 6    
7.Muhlemann MF, Carter GD, Cream JJ and Wise P : Oral spironolactone : an effective treatment for acne vulgaris in women, Brit J Dermatol, 1986; 115 : 227-232.  Back to cited text no. 7    
8.Messina M : A new therapeutic approach to treatment of acne, Cur Therap Res, 1983; 34 319-323.  Back to cited text no. 8    
9.Buckshee K and Ahuja MMS : Therapeutic evaluation of effectiveness of cimetidine in the treatment of hirsutism, Ind J Med Res, 1985; 82 562-564.  Back to cited text no. 9    
10.Biffignandi P, Massucchettic and Mounatti GM Free estradiol increase with concomitant decrease of free testosterone in plasma from normal men after incubation with spironolactone, Horm Metabol Res, 1983; 15 : 55-58.  Back to cited text no. 10    
11.EI C and Edelsen SK : The use of human skin fibroblasts to obtain potency estimates of drug binding to androgen receptors, J Clin Endocrinol Metabol, 1984; 59 : 51-57.  Back to cited text no. 11    


    Tables

[Table - 1], [Table - 2]

This article has been cited by
1 Effect of spironolactone on acne vulgaris - A double blind study
Mansurul, A., Maidul Islam, A.Z.M.
Bangladesh Journal of Dermatology, Venereology and Leprology. 2000; 17(1): 1-4
[Pubmed]



 

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