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Dianette For Acne: Review Of Treatment With A ‘Pill’

Dianette-For-Acne-Review-Of-Treatment-With-A-‘Pill

Acne is a common skin condition. In the UK, more than 3.5 million visits are made by patients to GP practices who seek treatment for this condition.

The first-line treatment for acne includes topical preparations, such as topical retinoid products topical antibiotics, alone or in combination with benzoyl peroxide (NICE, 2018).

Hormonal treatment is recommended when patients do not respond to first-line therapy and optional systemic (oral) antibiotics.

Skin

Today, I review the use of Dianette for acne treatment, a hormonal (contraceptive) pill available as a prescription-only medication. Do note this is available as a prescription-only medication, and you cannot buy Dianette without a prescription.

What Is Dianette® Pill?

Dianette® pill, also known under the generic name of Co-Cyprindiol, contains a mixture of cyproterone acetate (an antiandrogen) and Ethinylestradiol (Oestrogen).

Dianette® is licensed for:

DIANETTE PILL

Treatment of moderate-severe acne linked to androgen sensitivity in women in the childbearing potential

where other therapies such as topical and systemic antibiotics failed to produce results.

  • Treatment of hirsutism (excessive hair growth in women)
  • Hormonal contraceptive (although it is not recommended for use as a contraceptive only (NICE, 2019))

Dianette For Acne: Treatment Guidelines

Hormonal contraceptives such as Dianette are not recommended as first-line treatment in the management of acne. Combined oral contraceptives are used for people with moderate acne who did not respond to topical (skin) treatment. This form of acne treatment is optional with oral antibiotics such as Lymecycline or Doxycycline.

Dianette (Co-cyprindiol) should be used with topical treatment (NICE, 2018).
The official NICE guide for the treatment of acne vulgaris recommends discontinuation of the therapy with Co-cyprindiol (Dianette®) three months after symptoms of acne have been resolved / under control (ibid).

How Long Does It Take For Dianette Pill To Work?

Treatment of at least three months is needed to relieve symptoms of acne (eMC, 2019).

Quick FAQ

How long does it take Diana to do her work?
Within a few weeks of starting Dianette, you should see a reduction in oily skin, but it may take at least three months of therapy to observe a significant improvement in acne or hair growth.

How Is Dianette For Acne Taken?

One Dianette pill is taken daily for 21 days, followed by 7 pill-free days. The first pill should be taken on day one of the menstrual cycles.
Since Dianette is a contraceptive pill, no other contraceptive pill should be taken simultaneously.

How Does Dianette® Pill Help With Acne?

The sebaceous glands and sebum production are in the center of acne development. Sebum is an oily substance that has a role in skin and hair lubrication. The production of sebum in the body is controlled using androgens (sex hormones).

Sebum production increases from around 9 until 17, when adulthood levels are reached (Zouboulis, 2004). Overproduction of sebum leads to blockage of hair follicles, leading to acne development.

Cyproterone acetate, one of the components of Dianette, is an antiandrogen, which reduces the actions of hormones such as testosterone and consequently helps with the management of acne symptoms.

Dianette For Acne: A Review Of Side Effects

Common side effects associated with Dianette use:

  • Nausea
  • Abdominal pain
  • Weight gain
  • Headaches
  • Depressed mood
  • Breast pain and/or breast tenderness

Dianette for acne: a review of side effects

Additionally, as with other combined oral contraceptives, taking Dianette for acne slightly increases the risk of venous thromboembolism (VTE), an emergency where a blood clot is formed in the body.

This usually happens in the leg or groin (this type of thromboembolism is called Deep Vein Thrombosis). A clot that is formed travels to the lungs and causes a blockage (this type of thromboembolism is called pulmonary embolism).

The formation of a blood clot in the artery in the brain may cause a stroke, whereas a block of the vein in the heart can lead to a heart attack. VTE can be fatal.

Quick FAQ

Can Dianette led to weight gain?
When it comes to the predisposition to gain weight, any contraceptive pill has the potential to induce fluid retention and weight gain, especially in the first two or three months of usage.

Dianette Blood Clot Risk (eMC, 2019)

The overall risk of VTE for women taking combined oral contraceptives is small (FSRH, 2019).

  • Up to 40 women out of 100,000 women who take Dianette or the pill will have a clot in a year.
  • About 5-10 women out of 100,000 who are not taking Dianette or other pills and are not pregnant will have a blood clot in a year.

Quick FAQ

Is it possible to become pregnant on Dianette?
If you take your pills correctly and start the next pack on schedule, you are pretty unlikely to become pregnant during the 7-day gap from taking the pill.

Certain factors increase the risk of having a blood clot in the artery, some of which include:

  • Being a smoker
  • Being overweight
  • High blood pressure
  • Being a diabetic
  • Having a close family member who had a heart attack or stroke at a young age
  • Being immobilized for a long time (for example, after a surgery)
  • Increasing age

What About Breast And Cervical Cancer Risks?

Other risks associated with the use of combined oral contraceptives include (ibid)):

  • A small increased risk of breast cancer reduces with time after the combined oral contraceptive is stopped
  • There is a small increased risk of cervical cancer in patients who take combined oral contraceptives for more than five years, which reduces with time after the combined oral contraceptive is stopped. Risk is no longer increased ten years after stopping the combined pill.

Published research calls the above risks ‘misconceptions’ of combined oral contraceptive use (Katsambas & Dessinioti, 2010).
Refer to the product information leaflet for a list of all risk factors.

Can Anyone Use Dianette For Acne?

Certain patients cannot use the Dianette pill for the treatment of acne.

  • Patients with history or present venous thrombosis
  • Patients with a current or history of myocardial infarction (heart attack), angina, or ‘mini’ stroke
  • History of present cerebrovascular accident
  • Patients with multiple health-related risk factors such as diabetes, severe high blood pressure or high cholesterol or triglycerides (fats)
  • History of migraines with aura
  • History of present liver tumour or breast cancer
  • Suspected pregnancy or breastfeeding
  • Liver disease
  • Predisposition for venous or arterial thrombosis, for example, a family history

World Health Organisations list the following ‘absolute’ contraindications for the use of combined oral contraceptives (WHO, 2003):

abdominal apin

  • Pregnancy
  • History of heart disease or thromboembolism (obstruction of a blood vessel by a blood clot)
  • History of liver disease
  • Patients aged 35 or over and who are smokers

Dianette For Acne: Prescription Charges

In the UK, all contraceptive pills are free of charge; however, this does not apply to Dianette or Co-cyprindiol when prescribed for acne treatment. Most commonly, Dianette is prescribed for acne treatment rather than as an oral contraceptive, although both are licensed indications for this pill.

To avoid a prescription charge, a prescriber needs to add an endorsement to the prescription ‘CC,’ ‘OC,’ or the female symbol (♀) to clarify that Dianette is (also) used as a contraceptive.

Dianette For Acne: What Are The Alternative Options?

As we learned from this post, Dianette is not recommended as a first-line acne treatment. The following classes of drugs are used in the management of acne:

  • Topical preparations of benzoyl peroxide and azelaic acid
  • Topical antibiotics with or without benzoyl peroxide, for example, Duac Once Daily Gel. Read Duac Once Daily Gel – 15 Facts You Must Know to learn more about Duac.
  • Oral antibiotics such as Lymecycline
  • Topical retinoids (tretinoin) and adapalene
  • Oral isotretinoin

You can read more about the most popular antibiotic treatment for acne in a separate post: Best antibiotics for acne – UK list.

Dianette For Acne: Conclusion

Dianette is an effective contraceptive pill licensed for the treatment of acne. Although not recommended as a first-line treatment of acne, Dianette® offers a good treatment option for women who require acne treatment and hormonal contraception. Patients should discuss the most suitable treatment and possible associated risks with their prescriber.

Quick FAQ

How do you take Dianette for acne?
Dianette is taken simultaneously, each day for 21 days, followed by 7 days pill-free interval.
How quickly does Dianette clear skin?
Treatment of at least three months is needed to clear the symptoms of acne.
Can Dianette cause depression?
Depression is listed as a common side effect of Dianette use. Reports of severe depression in patients using Dianette exist. Depressed mood and depression are known side effects of hormonal contraceptive use.
Which birth control pill is best for acne?
In the UK, hormonal contraceptive licensed for acne treatment contains Co-cyprindiol (cyproterone acetate with ethinylestradiol). Co-cyprindiol is available as a generic drug or under the branded name of Dianette.
References