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Fig. 11.21a, b. Improvement of papulo-pustular acne (a) after 3 sessions pf 25% TCA peeling (b). This patient has been treated with oral isotretinoin 6 months before peeling procedure.

tests and lipid profile is suggested before starting and during isotretinoin treatment.

Hormonal therapy can be an effective treatment in females affected by inflammatory acne. Different varieties of hormonal therapies are available. Oral estrogens are used due to their anti-acne effect by decreasing the level of circulating androgens and increasing sex-hormone-binding protein. In contraceptive pills estrogens are administered as a combination with

Fig. 11.21c, d. Improvement of papulo-pustular acne (c) after 3 sessions pf 25% TCA peeling (d). This patient has been treated with oral isotretinoin 6 months before peeling procedure.

progestins. The most used estrogenic component is largely ethinyl estradiol. Second-generation progestins (ethynodiol diacetate,norethin-drone, levonorgestrel) and third-generation progestins (desogestrel, norgestimate, gesto-dene) have a lower androgenic activity than first-generation progestins. Inflammatory lesions, scarring and severe seborrhea can suggest the administration of the combination oral estrogen/progestin in women. The improvement is usually slow.

Cyproterone acetate (CPA) is a progestational anti androgen that blocks the androgen receptors. It is combined with ethinyl estradiol in an oral contraceptive formulation, which is indicated in female acne patients with a high level of seborrhea, therapy resistant papulo-pus-tular acne or acne conglobata not responding to other treatments.

Spironolactone is an antiandrogen which blocks androgen-receptors, alters steroidogen-esis by adrenals and gonads and inhibits 5-a reductase. In doses of 100-200 mg daily it reduces sebum production and improves inflammatory acne in women. During treatment, birth control measures are required due to the risk of male fetus feminization.

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