Contraception and the Dermatologist

In the June 2013 document, the authors explored the intersection of contraception and dermatology, focusing on the treatment of acne and the importance of contraception when prescribing teratogenic medications. They found that combined oral contraceptives (COCs) can be beneficial for acne management, although the type of progestin in COCs can affect their efficacy. Long-acting reversible contraceptives (LARCs) are recommended for women taking teratogens, despite the potential for worsening acne. The document also discussed the iPledge program's shortcomings in preventing fetal exposure to isotretinoin, due to noncompliance with contraception. The authors recommended LARCs as the first-line contraceptive for women on teratogens. They reviewed the FDA-approved COCs for acne and the associated risk of thromboembolism with drospirenone-containing COCs, suggesting that the benefits might outweigh the risks. Additionally, the document cited a Danish study on the low risk of thrombotic stroke and myocardial infarction with hormonal contraception. It provided guidance on which patients might benefit from COCs for acne, those who are not suitable candidates, and the side effects, including potential hair loss upon discontinuation. Progesterone-only contraceptives were noted to potentially worsen acne. The Essure system was mentioned with a caution about nickel hypersensitivity. The conclusion emphasized the need for dermatologists to be knowledgeable about contraceptive options and their dermatologic side effects, especially when prescribing teratogens, and recommended conservative treatment for suspected nickel sensitivity from Essure implants.