Oral contraceptives and spironolactone may be good options for managing acne in females who have sudden onset of severe acne, who have not responded to conventional first-line therapy, or who have persistent inflammatory papules and nodules involving primarily the lower face and neck. Hormonal therapies may be especially beneficial in female patients with hyperandrogenism, a need for birth control, or irregular menses.
Maintenance therapy should be initiated once clinical improvement is achieved, particularly in the young teenager in whom acne is likely to recur. Counseling is essential to the management of patients with acne, including assessing any adverse psychological effects of the condition, and dispelling myths (such as an acne-chocolate link), the authors advised.