I have had acne since I was a teenager. I have tried many treatments, including three types of antibiotics and several creams. I am now in my twenties and still suffer with it. My doctor has suggested I use the oral contraceptive Dianette.

But I am worried about the long-term effect this will have on my body?

Dianette is a combined pill. It is used mainly for the treatment of acne but is also an effective contraception.

You don't mention whether you are a smoker or not. If you have normal blood pressure and don't smoke, there is no reason why you should not take it.

Taking the combined pill does slightly increase a woman's risk of heart attack and stroke, but this risk increases significantly if you smoke.

Dianette should not be taken for more than three-four cycles after your acne has completely resolved. If your acne returns, repeat courses can be given.

I read that this type of pill has an anti-testosterone effect. How can this affect me?

Yes, that is right. Dianette contains two ingredients, cyproterone and ethinylestradiol. Cyproterone is an anti-androgen and works by reducing the amount of androgen produced. Too much androgen can cause the glands in the skin that produce sebum (grease) to become blocked and inflamed, causing acne spots to develop. Loss of libido can be a common complaint of women taking this type of pill. But apart from stopping the pill, there is no easy answer to this problem.

Can women not take testosterone supplements to help with a loss of libido?

While testosterone is the libido hormone in both sexes, it has been shown to have little benefit in women and causes side-effects such as spots, hairiness, a deep voice and enlargement of the clitoris. There is a testosterone skin patch called Intrinsa available but this is recommended only for women who have had an early surgically-induced menopause.

If I chose not to take Dianette, what else can be done for severe acne?

Ask your doctor to refer you to a dermatologist, who can treat problematic acne. The aim should be to prevent scarring. However, even if this occurs, your dermatologist may suggest microdermabrasion or dermabrasion. Laser resurfacing, which removes the damaged top layer of skin, is another option.

A newer form of treatment for acne scarring is called fractional laser therapy. This works at a deeper level than laser resurfacing or dermabrasion. Because it doesn't wound the top layer of tissue, healing time is shorter.

There is also a form of light treatment available for mild to moderate acne, Dermalux AV. This exposes the skin to certain wavelengths of light in part of the blue or red spectrum. This claims to kill the bacteria propionibacterium acnes that can cause acne.

- Niamh Houston