AAD
Author: Willhemenia Loremipsum Special session: Lorem ipsum dolor sit amet Category: Lorem ipsum View all results

Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.

  • Presentation

Contraception in Acne and Rosacea

Description

The presentation covers the role of contraception, specifically combined oral contraceptives (COCs), in managing acne and rosacea, stressing their FDA approval and effectiveness for acne treatment. It addresses the mechanism by which COCs lower androgens, thus improving acne symptoms, and highlights the importance of assessing patient suitability before prescribing, including checking for drug interactions and contraindications such as hypertension and migraines with aura. Despite their efficacy, a surprising number of dermatologists opt not to prescribe them, often due to a lack of confidence in counseling about them or a perceived comfort with alternative treatments. The talk emphasizes the significance of shared decision-making, as COCs can address not just acne but also menstrual issues and serve as a contraceptive. The speaker points out that counseling about emergency contraception is crucial, especially for patients on isotretinoin to prevent pregnancy from occurring with this known teratogen. Emergency contraceptive methods such as Plan B and Ella are discussed, with attention to their use and effectiveness, particularly in patients who may be reluctant to use regular contraceptives. The talk concludes by urging dermatologists to consider the holistic benefits of combined oral contraceptives and to actively provide guidance on emergency contraception.

View more

Conclusions

  • Combined oral contraceptives (COCs) are FDA-approved for acne treatment and are effective in managing both inflammatory and non-inflammatory lesions.
  • Dermatologists face a significant practice gap, as only about 55% prescribe COCs for acne despite their approval and effectiveness.
  • Proper patient assessment is crucial before initiating hormonal therapies, including evaluating for potential contraindications like hypertension or a history of thrombosis.
  • Counseling patients on the use of COCs can address additional health concerns, such as dysmenorrhea and abnormal uterine bleeding, providing comprehensive care.
  • Emergency contraception (EC) is underutilized among dermatologists, highlighting the need for better education and counseling on this topic.
  • Patients need to be informed about the risks and benefits of COCs, including potential effects on bone density in adolescents and concerns about thromboembolic events.
  • Effective contraceptive strategies are essential for patients on isotretinoin to prevent pregnancy, given the medication's teratogenic risks.
  • COCs should be considered in conjunction with other treatments like spironolactone for patients with acne, especially those presenting with hirsutism.
  • There is misinformation surrounding hormonal contraceptive methods, particularly regarding weight gain, which should be addressed in patient counseling.
  • Swink SM, Jones-Sheets MA, Sinharoy A, Butt M, Gust A, Zaenglein AL. Evaluating Dermatology Residents Combined Oral Contraceptive Pill Prescribing Practices, Knowledge, and Comfort Level in the Management of Acne Vulgaris: A Cross-sectional Survey Study. J Clin Aesthet Dermatol. 2023 Jan;16(1):47-50.
  • Powell A. Choosing the Right Oral Contraceptive Pill for Teens. Pediatr Clin North Am. 2017 Apr;64(2):343-358.
  • Kraft MZ, Rojczyk P, Weiss T, Derntl B, Kikinis Z, Croy I, Heller C. Symptoms of mental disorders and oral contraception use: A systematic review and meta-analysis. Front Neuroendocrinol. 2024 Jan;72:101111.
  • Reynolds RV, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2024 May;90(5):1006.e1-1006.e30.
  • Koo EB, Petersen TD, Kimball AB. Meta-analysis comparing efficacy of antibiotics versus oral contraceptives in acne vulgaris. J Am Acad Dermatol. 2014 Sep;71(3):450-9.
  • Munjal A, Tripathi R, Wu C, Radke S, Powers JG. Correlations between hormonal intrauterine devices and androgenic skin conditions: A retrospective cohort study. J Am Acad Dermatol. 2022 Nov;87(5):1112-1114.
  • Stitzlein E, Arza A, Gupta M, Ilyas EN. Incidence of rosacea after placement of intrauterine devices: a retrospective analysis. Arch Dermatol Res. 2024 Sep 28;316(9):650.
  • Kann L, McManus T, Harris WA, Shanklin SL, Flint KH, Hawkins J, Queen B, Lowry R, Olsen EO, Chyen D, Whittle L, Thornton J, Lim C, Yamakawa Y, Brener N, Zaza S. MMWR Surveill Summ. 2016 Jun 10;65(6):1-174.