BACKGROUND AND PURPOSE:

• Combined oral contraceptives (OCs) are used to treat acne
  • OCs with drospirenone appear to be particularly effective
• Some studies suggest that progestin-only methods may results in additional cases of acne vs combined OCs
• Barbieri et al. (Obstetrics & Gynecology, 2020) examined different contraceptive methods and their effects on incidence and severity of acne

METHODS:

• Retrospective cohort study
• Participants
  • Women 12 to 40 years of age
  • Within first year after initiation of contraception
• Study design
  • Data source: Deidentified commercial claims database
  • Acne severity: Subgroup analysis among a patient cohort with a history of acne
• Primary outcome
  • Acne incidence: No prior history
  • Acne severity: Prior history of acne: Incidence of treatment escalation from topical to oral tetracycline-class antibiotic

RESULTS:

• 336,738 women met criteria
  • Combined OCs (82.9%) | Levonorgestrel IUDs (10.6%) | Copper IUD (2.1%) | Etonogestrel implant (1.9%) | Progestin-only OC (1.3%) | DMPA injection (1.2%)
• Compared with combined OCs, the following were associated with an increased risk of clinical encounters with acne  
  • Copper IUD
    • Hazard ratio (HR) 1.14 (95% CI, 1.01 to 1.29)
  • Levonorgestrel IUD
    • HR 1.09 (95% CI, 1.03 to 1.16)
• Women who switched from OCs to another method were more likely to have clinical encounters for acne
  • Progestin-only OCs: adjusted HR 1.70 (95% CI, 1.23–2.35)
  • Levonorgestrel IUDs: adjusted HR 1.93 (95% CI, 1.69–2.22)
  • Etonogestrel implant: adjusted HR 1.45 (95% CI, 1.08–1.95)
  • Copper IUD: adjusted HR 1.70 (95% CI, 1.23–2.35)
• History of acne: 21,178 women
  • Compared with OCs, the following were associated with an increased risk of treatment escalation from topical acne medications to an oral tetracycline class antibiotic
  • Copper IUD
    • HR 1.44 (95% CI, 1.00 to 2.06)
  • Levonorgestrel IUD
    • HR 1.34 (95% CI, 1.10 to 1.64)

CONCLUSION:

• The authors point out that absolute differences between contraceptive methods and incidence of clinical acne encounters were small (<1%)
• Furthermore, the authors state that

…some of the observed associations in other studies between noncombined OC contraception classes and acne may be due to prior discontinuation of combined OCs before starting the noncombined OC contraception method, and that overall, large differences in the risk of acne between contraceptive classes are unlikely

Learn more – Primary Sources:

Influence of Contraception Class on Incidence and Severity of Acne Vulgaris

Related ObG Topics:

Is Progestin-Based Contraception Linked to Depression?

Hormonal Contraception Benefits – Beyond Pregnancy Prevention

Phase 3 Trial: IUD Efficacy and Safety at 5 Years