Estrogens: Estrogens include two major groups: estrogens and progestins. It is currently believed that androgens play a role in the development of acne. Female patients with moderate to severe acne who also have high androgen levels, manifestations of high androgen activity such as seborrhea, acne, hirsutism, androgenic alopecia (SAHA) or the presence of polycystic ovary syndrome (PCOS) should be treated with estrogen and progestin in a timely manner. Combined use of birth control pills may also be considered for women with late-onset acne and those whose acne worsens significantly before menstruation. The U.S. Food and Drug Administration (FDA) has approved birth control pills for the treatment of acne in women >15 years of age. The mechanism of action of oral estrogen and progestin in the treatment of acne: (1) Estrogen: (1) By reducing the excessive secretion of androgens caused by ovarian and adrenocortical hyperfunction, and by stimulating the synthesis of sex hormone-binding globulin (SHBG) in the liver, the concentration of active estrogen in the serum is reduced, which has an anti-sebaceous effect. ②Estrogen can increase the amount of SHBG synthesis and decrease the amount of free testosterone. (3) Estrogen has the effect of reducing the size of sebaceous glands and inhibiting lipid synthesis in sebaceous gland cells. (2) Progesterone: ① is a 5-alpha reductase inhibitor, which can reduce the amount of testosterone and dehydrotestosterone in plasma through negative feedback inhibition. (ii) It can inhibit the ability of sebaceous gland cells and keratin-forming cells to convert testosterone. (3) Cyproterone acetate can also block the binding of sex hormones to their receptors. (3) Estrogen and progesterone can also act directly on hair follicle sebaceous glands to reduce sebum secretion and inhibit acne formation. Oral contraceptives are a combination of estrogen and progestin, and the choice of the type of oral contraceptive is also very important. Some birth control pills contain sex hormone components, and certain synthetic progestins have cross-reactivity with androgen receptors, which can reduce SHBG and increase the amount of free testosterone, thus aggravating or causing acne. At present, the drugs often chosen to treat acne are compounded cyclopentone acetate tablets (Daine-35, Diane35, each tablet contains 2mg of cyclopentone acetate + 35ug of ethinyl estradiol), one tablet is taken on the first day of the menstrual cycle for 21d, stopped for 7d, and repeated after another period for 21d, effective after 2-3 months, and the course of treatment is 3-4 months. For patients with particularly high seborrhea, the effect of conventional treatment with contraceptive pills is often not good. The efficacy can be significantly improved by taking 50-100mg of cyproterone acetate on top of oral Daine-35 at 5-14d of the menstrual cycle. Adverse reactions include small amount of uterine bleeding, breast distension, upper abdominal discomfort and facial skin redness, weight gain, deep vein thrombosis, and appearance of chloasma. Shaowen Peng, Department of Dermatology and Venereology, General Hospital of Beijing Military Region Other anti-hormonal treatments: Antiseptic Antiseptic, also known as spironolactone, is an aldosterone compound. Mechanism of action: ①Competitive inhibition of dihydrotestosterone binding to the receptors of skin target organs, thus affecting its action and inhibiting the growth of sebaceous glands and sebum secretion. ②Inhibit 5-alpha reductase and reduce the conversion of testosterone to dihydrotestosterone. The recommended dose is 1-2mg/(kg.d) for 3-6 months. Adverse effects are menstrual irregularities (probability of occurrence is positively correlated with dose), nausea, drowsiness, fatigue, dizziness or headache and hypercalcemia. Contraindicated in pregnant women. Not recommended for male patients, who may experience breast development and breast tenderness after use. Mecamidine (cimetidine) has a weak anti-androgenic effect, competitively blocking the binding of dihydrotestosterone to its receptors, but does not affect serum androgen levels, thereby inhibiting sebum production. The recommended dose is 200 mg 3 times daily for 4-6 weeks. Glucocorticoid application: Glucocorticoids have the ability to inhibit androgen secretion caused by hyperadrenocorticism, anti-inflammatory and immunosuppressive effects. Oral glucocorticoids are mainly used for fulminant acne or coalescent acne, because these types of acne are often associated with excessive immune response and inflammation, and brief use of glucocorticoids can play an immunosuppressive and anti-inflammatory role. However, care should be taken that glucocorticoids themselves are anti-inflammatory and trigger acne. Oral administration is only available for patients with more severe inflammation and in small, short-term doses. Recommended doses: ①Fulminant acne: Prednisone 20-30 mg/d for 4-6 weeks, followed by a gradual reduction over 2 weeks and the addition of oral retinoic acid. (ii) In case of aggravation of acne conglobata or acne fulminans during oral treatment with retinoic acid, prednisone 20-30 mg/d for 2-3 weeks, followed by a gradual reduction in dose over 6 weeks; at the same time, discontinue oral retinoic acid or reduce the dose to 0.25 mg/(kg.d), and then increase or decrease the dose according to the condition. ③ Prednisone 5 mg/d or dexamethasone 0.375-0.75 mg/d, taken every night, is an anti-inflammatory to inhibit the high secretion of pro-adrenal hormones early in the morning and inhibit the production of androgens by the adrenal glands and ovaries, and is gradually reduced after improvement. For patients with acne that worsens before menstruation, prednisone 5 mg/d can be started 10 d before menstruation until the onset of menstruation. Fisher et al. suggested that high doses of glucocorticoids have anti-inflammatory effects, while low doses have anti-androgenic effects.