monitor.2 Additionally, increasing bacterial resistance to antibiotics has made it inadvisable to prescribe topical or systemic antibiotics as monotherapy or for longer than 3 to 6 months.1,2,7
Androgen hormones are involved in the increased sebum production and inflammation that lead to acne, but androgens have historically been difficult to target with medication.8-11 For example, OCPs inhibit the production of androgens but can only be used in a subset of women and carry an undesirable side effect profile including increased cardiovascular side effects, headaches, and menstrual irregularities.3,10,11 Spironolactone is another anti-androgen that can be prescribed off-label to treat hormonal acne, but this medication is often not tolerated in men due to its potential systemic side effects, including gynecomastia.3,10,11 Neither OCPs nor spironolactone should be used during pregnancy due to their potential effects on fetal development.3,6,9,12 Both of these medications are inseparable from their adverse effects because they are systemic in nature.10
