Dermatologists have long recognised that progesterone-only hormonal contraception is associated with new or worsening acne in up to one third of adult patients.
[Lortscher D, Admani S, Satur N et al. Hormonal contraceptives and acne: a retrospective analysis of 2147 patients. J Drug Dermatol 2016;15(6):670-674.]
On the other hand, combined oral contraceptives (COC) that contain oestrogen and progesterone are recommended in the treatment of moderate to severe acne, especially when contraception is also an issue. This is due to the COC reducing the amount of androgens (male hormones) produced by the ovaries and increasing levels of another protein called sex hormone binding globulin.
It was interesting to read an article looking at the use of long acting progesterone-releasing contraceptives (LARC), namely the hormone releasing intra-uterine device (IUD) or Mirena coil and the implant and their effects on teenage acne.
[Boos MD, Ryan ME, Milliren C et al. Relationship between long-acting reversible contraception and acne in a cohort of adolescents and young adults. Pediatr Dermatol 2024;1-7]
What did the authors do?
They looked at all adolescents presenting for LARC at adolescent services at various hospitals in Boston, Los Angeles, New York and Seattle. Acne was scored during the physical examination as none, mild, moderate, severe or cystic. At subsequent follow up and LARC removal visits, side effects and reasons for removal were listed.
How many patients were involved in the study?
There were around 1300 study participants and around 500 had switched from another form of hormonal contraception. A quarter (317 of 1319) had documented acne at the time of LARC insertion.
28.5% (376 patients) reported worsening acne over the study period and only 44 (11.7%) were on oral anti-acne medication for this.
What happened if the LARC was removed?
41.1% (542) had their LARC removed and only 40 of these 542 (7.4%) reported having their device removed due to acne. 18 of these 40 had acne at insertion of their LARC. There was no association between type of LARC (IUD vs implant) and worsening of acne.
So what can we conclude from this study?
The authors confirm that there have been many studies confirming the increased risk of acne in females switching to a progesterone-only contraceptive when compared with a COC (combined oral contraceptive containing oestrogen and progesterone). They do however, comment that this is also seen in females discontinuing a COC and switching to a non-hormonal IUD.
They postulate that the risk of developing acne on a progesterone only contraceptive may reflect the protective effect of the COC and not the androgenic effect of progesterones. Their study showed that switching to LARC from other forms of combined hormonal therapy was not more likely to cause acne compared to those that were switching from other contraceptive methods.
They conclude that the relative and absolute risk of acne is small, the acne is largely manageable and rarely warrants the LARC to be removed.
Kind regards,
Sandy
Dr Sandy Flann, Consultant Dermatologist.
