Effect of low dose cyproterone acetate on the response of acne to isotretinoin

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Abstract
Males with severe acne (27) were treated for 12 wk with 0.05 mg/kg day-1 isotretinoin (10 patients) or 5 mg daily cyproterone acetate (8 patients) or both drugs together in these doses (9 patients). With isotretinoin, the sebum excretion rate (SER) fell by 45 .+-. 9% SEM [standard error of the mean] (P < 0.0025), lesion count fell by 65% .+-. 10% (P < 0.0005) and median clinical severity fell from 8 to 2.5 (P = 0.01). With cyproterone acetate there was a 17 .+-. 12% (NS not significant) fall in SER, a 15 .+-. 10% (NS) fall in lesion count and the median severity was unchanged. Patients treated with both drugs showed a 42 .+-. 13% reduction in SER (P < 0.005), a 68% .+-. 11% decrease in lesion count (P < 0.0005) and a decrease in median severity from 8 to 4 (P < 0.01) which was no different from the response to isotretinoin alone. Isotretinoin increased serum cholestrol from 4.4 mmol/l .+-. 0.3 SEM to 4.7 mmol/l .+-. 0.3 SEM (P < 0.01), serum triglyceride from 0.73 mmol/l .+-. 0.07 SEM to 0.96 mmol/l .+-. 0.14 SEM (P < 0.05) and .gamma.-glutamyltransferase (GGT) from 15.9 i.u./l .+-. 2.1 SEM to 19.0 i.u./l .+-. 2.4 SEM (P < 0.01). Comparison of the area under the concentration-time curve for triglyceride and high density lipoprotein (HDL)-cholesterol showed that the changes were smaller when isotretinoin was combined with cyproterone acetate. The effect of isotretinoin in acne was not enhanced by the antiandrogen, but the increase in serum triglyceride and decrease in HDL-cholesterol produced by the retinoid were reduced by combination with the antiandrogen.