***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The effect of oral spironolactone ( 200 mg daily ) on acne vulgaris has been studied in 21 women in a r and omized , placebo‐controlled , double‐blind crossover study using 3 month treatment periods . Compared with placebo , spironolactone produced significant improvement as assessed by subjective benefit ( P<0.001 ) , number of inflamed lesions ( P<0.001 ) and by an independently evaluated photographic method ( P<0.02 ) . There was a fall in sex hormone binding globulin but no significant changes in plasma testosterone and derived free testosterone . Initial plasma and rogen levels were no higher in responders than in non‐responders , nor did oral contraceptive use appear to affect clinical response . Spironolactone is a useful alternative therapy for women with acne vulgaris Background The use of oral flutamide is rarely investigated in acne therapy . The aim of this study was to compare the efficacy of oral flutamide with that of a cyproterone-estradiol combination in treating  acne lesions .  Methods A r and omized clinical trial enrolled patients with moderate acne into two equal groups to receive either oral flutamide or the cyproterone-estradiol combination for 6 months . Lesion count , Acne Severity Index , and Global Acne Grading system ( GAGS ) scores were used to assess improvement in acne lesions . The dichotomous measurement scale for primary endpoint assessment was defined as improvement from moderate to mild acne based on GAGS score . Patient satisfaction and dermal fat were also assessed . Intention to treat and per protocol analyses were done , reporting related effect sizes . Results Both treatments result ed in substantial improvement in acne lesions . Although flutamide seemed to have higher efficacy , an intention to treat analysis did not find the two treatment protocol s to be different . The relative risk in intention to treat analysis was 1.8 ( 95 % confidence interval [ CI ] 0.89–1.6 ) , and was 1.33 ( 95 % CI 1.03–1.72 ) for the per protocol analysis . The number needed to treat for flutamide compared with the cyproterone-estradiol combination was 7.7 and 4.2 in the intention to treat and per protocol analyses , respectively . Conclusion Flutamide appears to be more effective than a cyproterone-estradiol combination in some aspects of acne treatment , but this requires confirmation in a larger trial BACKGROUND The use of either oral contraceptives or anti and rogens has been shown to be helpful in the treatment of women with acne . OBJECTIVES We investigated the safety and efficacy of acne treatment using both spironolactone and a combined contraceptive containing drospirenone . METHODS Twenty-seven women with either severe papular or nodulocystic facial acne were treated with a combined oral contraceptive containing 30 mug ethinyl estradiol and 3 mg drospirenone ( EE/DRSP ; Yasmin ) and spironolactone ( SL ) 100 mg taken daily . A serum potassium level was obtained before initiation of therapy . Between 4 and 6 weeks after the start of both medications , a second serum potassium level was obtained . Side effects were recorded . RESULTS No significant elevation of serum potassium was found in any of the subjects nor were there any reported additional side effects significant enough to discontinue treatment . At follow up , 85 % of subjects were entirely clear of acne lesions or had excellent improvement , 7.4 % were mildly improved , and 7.4 % were not improved . LIMITATIONS This was a small prospect i ve study . CONCLUSION The combination of EE/DRSP and SL 100 mg daily appears to have efficacy and is well tolerated in the treatment of severe papular and nodulocystic acne in women The effect of spironolactone on female hirsutism was studied in 18 patients . The drug was administered at the dose of 400 mg for the first ten days and 300–200 mg later on in a first group of women ( Group A ) ; a second group ( Group B ) was given 200 mg spironolactone for the whole length of therapy . A significant decrease of the index of Ferriman and Gallwey ( p = 0.01 ) was noted from the 100th day of treatment ; acne and seborrhoea improved concomitantly . Plasma total testosterone values fell from 0.64 + 0.24 ng/ml to 0.32 ± 0.12 ng/ml ( p = 0.002 ) during the first 5 days only in the patients of Group A ; in the other patients no significant changes were observed . PRL did not significantly change from prefreatment values ; FSH and LH values at the 5th , 10th , and 15th day of therapy did not show a uniform course in both groups . On the basis of these results spironolactone administration appears promising in the therapy of female hirsutism The aim of this study was to assess the usefulness of ketoconazole as a therapeutic alternative to polycystic ovary syndrome . The study group comprised 37 women with signs of hyper and rogenism ( hirsutism , acne ) and oligomenorrhea . A low dose ( 400 mg/day ) of ketoconazole was tested in a 9-month prospect i ve clinical study . Clinical response ( Ferriman & Gallway score , acne ) and modifications in hormone pattern ( luteinizing hormone , follicle-stimulating hormone , estradiol , testosterone , prolactin , 17-hydroxy-progesterone , and rostenedione , steroid hormone-binding globulin , dehydroepi and rosterone sulfate , cortisol , adrenocorticotropin ( ACTH ) and free testesterone index ) were measured , and ACTH stimulation tests were performed . Tolerance and side-effect also were assessed . After 9 months of ketoconazole treatment , the patients ' Ferriman & Gallway scores ( 18.26 + /- 4.6 vs 12.4 + /- 4.1 ; p < 0.001 ) and acne had improved markedly . Hormone patterns also became more favorable , with decreases in and rogenic steroids ( testosterone , and rostenedione , free testosterone index and dehydroepi and rosterone sulfate ; p < 0.01 ) and increases in estradiol ( p < 0.01 ) . Basal cortisol levels and cortisol after ACTH stimulation were not changed significantly , remaining within the reference range . Increases in ACTH were observed only in the 3rd month ( p < 0.01 ) . Initial levels of and rogenic steroids were correlated inversely with their percentage decrease in successive samplings . Decreases in adrenal and rogenic steroids were associated with an increase in steroid hormone-binding globulin . The side-effects of treatment , although not severe , caused some discomfort and led to a high drop-out rate ( 30 % ) . ( ABSTRACT TRUNCATED AT 250 WORDS This double-blind study compared the efficacy and tolerability of a combined oral contraceptive containing 30 microg ethinyl estradiol and 3 mg drospirenone ( EE/DRSP ; Yasmin ) with a triphasic preparation containing 35 microg EE and 0.180 , 0.215 , 0.250 mg norgestimate ( EE/NGM ; Pramino , also known as Ortho Tri-Cyclen ) in the treatment of acne vulgaris . The combined presence of anti and rogenic and antimineralocorticoid activities of drospirenone is unique to this novel progestin in that these characteristics most closely resemble those of progesterone . The study was design ed to show that EE/DRSP was noninferior or superior to EE/NGM as to the relative decrease from baseline to cycle 6 in percentage of inflammatory and total lesion counts and the investigators ' assessment of acne improvement . Other outcomes included subjects ' assessment of therapeutic effect , sebum production , and hormone levels .  Female subjects were r and omized to EE/DRSP ( n = 568 ) or EE/NGM ( n = 586 ) for 6 treatment cycles , consisting of 21 consecutive days of hormone intake , followed by 7 hormone-free days . The preparation containing EE/DRSP was superior to EE/NGM for reduction in total lesion count ( -3.3 % in favor of EE/DRSP [ 95 % CI , -6.5 to -0.1 ; P = .020 ] ) and for investigators ' assessment of therapeutic effect on facial acne ( + 3.6 % in favor of EE/DRSP [ 95 % CI , 0.8 to 6.3 ; P = .006 ] ) . The 2 preparations were comparable as to their decreases in inflammatory lesion count . Evaluation of the effect of treatment by subjects was consistent with that of the investigators . Furthermore , both preparations increased the level of sex hormone-binding globulin ( SHBG ) and decreased the levels of and rogens , changes typically associated with acne improvement . Both preparations were well tolerated . In conclusion , owing to the unique pharmacologic activities of drospirenone , the combined oral contraceptive EE/DRSP provides an effective treatment option in female patients with mild to moderate acne An open , r and omized , multicenter study was carried out to compare two  oral contraceptives  as regards their  therapeutic efficacy  in and rogenization symptoms such as acne , seborrhea and hirsutism in women . The preparations used were the combination of 2 mg cyproterone acetate ( CPA ) with 0.035 mg ethinyl estradiol ( EE ) ( Diane35 ® , Schering AG , Berlin‐West ) and 0.150 mg desogestrel ( DG ) with 0.03 mg ethinyl estradiol ( Marvelon ® , Organon , Oss , The Netherl and s ) Since the recent introduction of a drug regimen containing 2 mg of the anti and rogen cyproterone acetate and 50 micrograms ethinyl-oestradiol ( Diane ; oestrogen-cyproterone acetate ) several uncontrolled reports have extolled the benefits of this drug . Double blind studies , however , are lacking . Sixty two patients with moderate or moderately severe acne were therefore included in a double blind trial of treatment for six months comparing tetracycline alone , oestrogen-cyproterone acetate alone , and a combination of these agents .  Sebum excretion rates and bacterial counts were measured before , during , and after treatment , at the same time as a clinical assessment was made . At six months the acne ( as assessed by overall grade ) had improved by 68 % in the antibiotic treated group and by 74 % in the oestrogen-cyproterone treated group . The group given a combination of both agents improved by 82 % , which was significantly better ( p less than 0.025 ) than the improvement in the tetracycline treated patients . No significant difference was found between the groups given oestrogen-cyproterone alone and the combined treatment . The sebum excretion rate was suppressed by 25 % in the patients in both groups receiving oestrogen-cyproterone but not in the group given antibiotics alone . Oestrogen-cyproterone acetate is as effective as antibiotics in treating acne in women , and adding antibiotics offers no advantage over using oestrogen-cyproterone on its own , although in this study the combination was more effective than tetracycline alone at six months OBJECTIVE To compare the combination spironolactone-norgestimate-ethinyl estradiol in hirsutism with other protocol s including the same dose of estrogen . STUDY DESIGN In this open prospect i ve study , 167 women with hirsutism due to polycystic ovary syndrome ( PCOS ) were r and omly assigned to the following treatment protocol s : Group A ( n = 72 ) : spironolactone 100 mg-norgestimate 250 mcg-ethinyl estradiol 35 microg ; Group B ( n = 70 ) : cyproterone acetate 12 mg-ethinyl estradiol 35 microg ; Group C ( n = 25 ) : norgestimate 250 microg-ethinyl estradiol 35 microg . RESULTS The decrease in the hirsutism score was higher in group A than in the other groups ( p < 0.001 ) and comparable in groups B and C. The decrease in acne score , and rogen and estradiol levels , and ovary volume was similar in groups A and B. C-reactive protein increase was similar in all groups , but the augmentation of fibrinogen ( p = 0.04 ) , triglycerides ( p < 0.01 ) , monocyte count ( p = 0.04 ) , platelet number ( p < 0.001 ) and mean volume ( p = 0.01 ) was more pronounced in group B than in group A. Low-density lipoprotein/high-density lipoprotein cholesterol ratio decreased in groups A and C. CONCLUSION Spironolactone-norgestimate-ethinyl estradiol is an effective and well-tolerated combination for the treatment of hirsutism in PCOS , with a favorable influence on lipids and indices of low- grade inflammation Ninety female patients with acne were allocated r and omly to one of three groups and treated either with Diane , a high dose cyproterone acetate ( CPA ) regime with ethinyloestradiol , or Minovlar . The same dose of oestro 
    Output:
    
Menstrual side effects were significantly more common with the 200 mg dose ; frequency could be significantly reduced by concomitant use of a COC .
Pooling of results for serum potassium supported the recent recommendation that routine monitoring is not required in this patient population .
Conclusion This systematic review of RCTs and case series identified evidence of limited quality to underpin the expert endorsement of spironolactone at the doses typically used ( ≤100 mg/day ) in everyday clinical practice