A teenage girl presented in OPD with moderate acne and history of irregular menses. What treatment will you give?
A teenage Girl is presenting with H/O irregular menses and acne both of which could mean excessive androgen production in females
Excessive androgen production in females leads to:
i. Hirsutism                       ii. Irregular Menses
iii. Acne                             iv. Seborrhea
v. Temporal Balding         vi. Clitoromegaly
“The physical manifestations of androgen excess generally reflect the extent to which androgen levels are elevated. Hirsutism is the most common complaint associated with androgen excess and essentially all women with hirsutism have an increased production rate of testosterone and androstenedione.” 
The management of excessive androgen production is -
i. Oral contraceptive pills-
Principle for using OCP’s
Estrogen component of OCP’s
Increases sex hormone binding globulin (SHBG) resulting in decreased free testosterone.
Progesterone suppresses LH resulting in decreased ovarian androgens.
The best oral contraceptives should be those which utilize a progestin with minimal androgenicity i.e. pills containing desogestrel, gestodene e.g. femilon and novelon.
OCP’s are effective in 60 — 100% patients with hirsutism, acne and seborrhea.
Remember: Hormone therapy must be continued for 6 months before judging its effectiveness.
Anti-androgens Cyproterone acetate: It is an antiandrogen which inhibits gonadotropin secretion and interferes with androgen action on the target organs by competing for the androgen receptors.
It should be administered along with ethinyl-estradiol to prevent menstrual irregularities and ovulation. it is available as combined estrogen — progestin oral contraceptive (2 mg cyproterone acetate and 35 ig ethinyl estrodiol as (Ginette or Diane 35)
“A combined pill containing 35 mcg ethinyl estrodiol and 2 mg of an ant-i-androgen cyproterone acetate (Diane 35 or Ginette) is the drug of choice in teenagers with irregular period and hirsulism. The effect on acne and seborrhea is evident shortly after starting treatment but 6-12 cycles are needed for a demonstrable effect on hirsutism.
Oral isotretinoin
Oral acitretin
Oral minocycline
Cyproterone acetate