Comparison of the efficacy between Isotretinoin, Cyproterone Acetate/Ethynil Estradiol and combination therapies in females with acne vulgaris

Acne vulgaris is the most common dermatologic disorder among young adults and isotretinoin is proven to be the most efficacious treatment in this disorder at this point. Although serum androgenic hormone levels have been studied oftenly in acne vulgaris; there are very few studies that enlighten the effects of isotretionin on serum androgenic hormon levels.In this study, our goal was to further understand the antiandrogenic effects of isotretinoin by using isotretinoin, cyproterone acetate/ethynil estradiol (CTA/EE) and isotretinoin+CTA/EE combination treatments and analyzing their effects on serum androgenic hormon levels and to the clinical presentation of acne vulgaris. 60 females that were clinically evaluated as grade IV-VIII on Allen-Smith scale were selected from our patient population for whom isotretinoin, CTA/EE or isotretinoin+CTA/EE combination treatment was planned.Fasting androgenic hormone levels were detected in venous blood by using RIA technique before treatment and on the third and the sixth month of the study. Individual androgenic hormone levels were compared within and in between the treatment groups. Similar to the CTA/EE combination treatment; the decrease of the serum androstenedion and free testosteron levels with isotretinoin treatment in females with acne vulgaris were found to be statistically significant (p<0,001) but such significance could not be shown for total testosteron and DHEAS levels (p>0,0056). There is no statistically significant change in LH/FSH ratio in isotretinoin monotherapy, so as in CTA/EE treatment (p>0,0056). Our study did not reveal any statistically significant relation between the severity of acne vulgaris and the androgenic hormone levels (p>0,05); similarly the change in androgenic hormone levels is not found to be correlated with the change in the clinical presentation of the disease as well (p>0,05). The cure ratios for females with acne vulgaris were shown to be 100%, 85% and 95% with isotretionin monotherapy, CTA/EE therapy and isotretinoin+CTA/EE combination therapy respectively.In summary, in this study isotretionin monotherapy is proven to have similar antiandrogenic effects to the other hormonal treatments and found to be superior clinically. No statistically significant correlation was found between the severity of acne vulgaris and the androgenic hormone levels. Given the clinical improvement of 85% with antiandrogenic treatment, androgenic hormones are likely to play a role in acne vulgaris pathogenesis by increasing the sebaceous gland hypersensitivity.Key words: acne vulgaris, isotretinoin, cyproterone acetate/ethynil estradiol, androgenic hormones