Hormonal Acne Therapy — SCE Dermatology MCQ
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Correct answer: D — Co-cyprindiol (Dianette — containing cyproterone acetate) or a COCP containing Drospirenone
The correct answer is D, co-cyprindiol (Dianette, containing cyproterone acetate) or a COCP containing drospirenone, because these preparations combine an oestrogen with a progestogen that has significant anti-androgenic activity, directly reducing sebum production and androgen receptor activation at the pilosebaceous unit. This is particularly relevant in PCOS, where hyperandrogenism drives acne, and NICE NG198 specifically recommends offering ethinylestradiol with cyproterone acetate or an alternative combined oral contraceptive pill as a treatment option when standard measures fail. Cyproterone acetate is a potent androgen receptor antagonist and also suppresses gonadotrophin release, while drospirenone has weaker but clinically useful anti-androgenic properties, making both licensed, evidence-based choices for hormonal acne. Because co-cyprindiol carries a higher VTE risk than second-generation COCPs, it should be reviewed and its continuation reconsidered after a defined period rather than used indefinitely.
Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/skin-conditions