The Role of Oral Contraceptive Pills in Hidradenitis Suppurativa: A Cohort Study

Abstract

There is a need to establish the role of antiandrogens as an alternative or concomitant therapy for hidradenitis suppurativa (HS). Thus, the objectives of this study are (1) to assess the effectiveness of oral contraceptive pills (OCPs) at week 12 in HS women, and (2) to describe the clinical profile of patients receiving oral contraceptive pills (OCPs). A prospective observational study was designed. This study included 100 participants, 50 women with HS who started OCPs for the first time at our HS Clinic and 50 participants without OCP treatment. The main outcome of interest was the percentage of reduction in total abscess and inflammatory nodule (AN) count at week 12. Thirty-three women received combined OCPs and 17 non-combined OCP. HS patients with OCPs treatment were younger (31.7 vs. 40.9 years, p < 0.001), thinner (28.62 vs. 33.35 kg/m2), and have a higher number of areas affected (2.32 vs. 1.38, p = 0.02) than those without OCPs. After 12-weeks of treatment, it was observed that the percentage of AN reduction was higher in HS women receiving OCP than in patients without OCP (53.9% vs. 38.42%, p = 0.049). It was observed that OCP prescription (β = 3.79, p = 0.034) and concomitant therapy (β = 3.91, p = 0.037) were independently associated with a higher % AN when controlling for disease duration, concomitant therapy, and treatment with/without OCP (R^2 = 0.67). The factors potentially associated with the percentage AN reduction at week 12 in HS women treated with OCPs were disease duration (β = −1.327, p = 0.052), concomitant therapy (β = 11.04, p = 0.079), and HS worsening with the menstrual cycle (β = 10.55, p = 0.087). In conclusion, OCPs might be effective for improving AN count in women with HS. Women whose HS worsens in relation to the menstrual cycle and have a shorter disease may benefit more from the therapeutic effect of OCPs.

Dermatopathologist Perceptions of Overdiagnosis, Physical Activity Among Long-Term Melanoma Survivors, and Lifestyle Modifications in Hidradenitis Suppurativa

“…Other popular interventions sought out by participants included different forms of menstrual regulation, with patients reporting the highest overall improvement with IUD devices. These findings were supported by a prospective cohort study of 100 women in which, after treatment, it was observed that the percentage of abscesses and inflammatory nodule reduction was higher in women with HS receiving oral contraceptive pills than in patients without OCPs (53.9% vs. 38.42%, p = .049;Montero-Vilchez et al, 2021). Therefore, lifestyle modifications through menstrual regulation may have positive effects on HS severity.…”

Practical Guidelines for Managing Patients With Hidradenitis Suppurativa: An Update

“…Combined oral contraceptive pills (OCPs) with a high estrogen to progesterone ratio and anti-androgenic progesterones, such as drospirenone or cyproterone acetate, have been used to treat HS in female patients of child-bearing age. 132 -135 The anti-androgenic activity of these OCPs is thought to be beneficial in reducing hormonal imbalances and the pro-inflammatory effects of excess androgens. 132 In Canada, three anti-androgenic OCPs are available for off-label treatment of HS: Yasmin ® , Yaz ® and Diane-35 ® (Table 4).…”

Special Issue “Reproductive Health Concerns for Women”

“…Hidradenitis suppurativa is an inflammatory disease which not only has a great impact on patient's quality of life, but also significantly impairs the fertility. Based on this consideration, the authors in the same group further provide the rationale and clinical evidence regarding the treatment for hidradenitis suppurativa [2]. Generally, treatment options for hidradenitis suppurativa include weight reduction, smoking cessation, topical clindamycin, oral contraceptive pills, oral retinoids, immunosuppressants and surgical management [3].…”

“…Generally, treatment options for hidradenitis suppurativa include weight reduction, smoking cessation, topical clindamycin, oral contraceptive pills, oral retinoids, immunosuppressants and surgical management [3]. Montero-Vilchez's study revealed that oral contraceptive pills are effective against hidradenitis suppurativa, especially in individuals whose symptoms worsen during the menstrual period [2]. Although the current article is promising, we still know little regarding the effects and exact pathophysiology of the hormonal impact on the development and management of hidradenitis suppurativa [3].…”

“…Besides female hormone-related skin disorders as shown above [1,2], leiomyoma of the uterus may be one of the most common benign disorders in women at reproductive age [4]. Among the various kinds of classification of leiomyomas, submucosal myoma is often associated with symptoms and health problems, which not only results in heavy menstruation and subsequent anemia, but may also impair the fecundity of women, increasing the risk of infertility and pregnancy loss [5].…”