Acne Vulgaris — SCE Dermatology MCQ

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ModerateInflammatory DermatosesAcne VulgarisSCE Dermatology

A 28-year-old woman has severe acne with deep nodules and cysts primarily on her jawline and lower face. She has irregular menstrual cycles and hirsutism. Testosterone is elevated. What hormonal treatment may be particularly beneficial?

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Correct answer: C — Combined oral contraceptive containing Cyproterone acetate (co-cyprindiol) plus topical retinoid

For women with acne and features of hyperandrogenism (jawline acne, hirsutism, irregular cycles, elevated androgens), anti-androgen therapy is important. Co-cyprindiol (Dianette — ethinylestradiol 35 mcg + cyproterone acetate 2 mg) provides both contraception and anti-androgen effect. Cyproterone acetate blocks androgen receptors and reduces androgen production. It is typically used for 3-6 months then reassessed due to VTE risk. Spironolactone (off-label, 100-200 mg daily) is an alternative anti-androgen. PCOS should be investigated. Combined hormonal therapy plus topical retinoid provides optimal management. Oral Isotretinoin may still be needed for severe disease.

Reference: BAD 2023 Acne Guidelines; NICE CKS