A randomized controlled trial of second- versus third-generation oral contraceptives in the treatment of acne vulgaris

Objective: This study was undertaken to compare the clinical efficacy of second- versus third-generation oral contraceptives in the treatment of acne. Study Design: Thirty-four women with acne were randomly selected to receive an oral contraceptive containing 0.3 mg of ethinyl estradiol (EE)/0.15 mg of desogestrel or 0.3 mg of EE/0.15 mg of levonorgestrel for 9 months. Acne was scored by lesion counting by a single examiner, and serum was analyzed for sex hormone-binding globulin (SHBG), dehydroepiandrosterone sulfate (DHEAS), and free and total testosterone at baseline and 3-month intervals. Results: At baseline, the two treatment groups did not differ in the mean age, body mass index, acne lesion counts, SHBG, DHEAS, or free and total testosterone. Mean acne lesion counts decreased significantly in both groups from baseline (P< .02). In subjects completing 9 months of therapy, acne decreased by 52.8% in the EE/levonorgestrel group (n = 9) and by 58.5% in the EE/desogestrel group (n = 7) (between groups: P not significant). Mean SHBG increased by 46.3 nmol/L in the EE/desogestrel group (P not significant), and 20.0 nmol/L in the EE/levonorgestrel group (P< .05). Decreases in free testosterone from baseline occurred in each group, but these differences did not reach statistical significance. Conclusion: Oral contraceptives containing EE/desogestrel and EE/levonorgestrel were both effective in treating acne. (Am J Obstet Gynecol 2003;188:1158-60.)