ZIT HAPPENS

Keep this in mind for your acne patients.

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1. Counselling Conundrum: a real question from a patient

2. Concise Conclusion: a straight-forward patient-friendly answer 

3. Quick Wrap-up 

Clearly, there are nuances that may not be captured in this format. The goal here is to provide you with helpful counselling tips which often draw from multiple sources or those which are not commonly accessed by busy healthcare providers serving the community.

Counselling Conundrum: "I switched birth control pills a month ago, only taking it for my acne, and my skin is actually worse than before. Should I stop it?"

Concise Conclusion: Stick with it a bit longer before judging it a failure. Any acne treatment, hormonal or not, typically needs about 3 months to show its full benefit, and getting worse before it gets better in that first month is the expected pattern, not a sign it's failing. The real checkpoint is month 3: if it hasn't turned the corner by then, that's worth a follow-up with your prescriber.

Quick Wrap-up: The 3-month rule applies broadly to acne therapies, but hormonal contraceptives add a wrinkle: switching formulations changes the progestin exposure, and some progestins (levonorgestrel, norethindrone) are more androgenic than others (drospirenone, cyproterone), so a switch can transiently worsen acne before the estrogen-driven SHBG increase and androgen suppression catch up. If there's no improvement by 3 months, consider whether the new progestin is actually a step backward rather than assuming more time will fix it. Red flags that warrant earlier follow-up regardless of the 3-month timeline: severe cystic or scarring acne, new migraine with aura, leg swelling/pain, or mood changes.

Dive Deeper

1) Combined oral contraceptive pills for treatment of acne - PubMed

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