Influence of contraception class on incidence and severity of acne vulgaris
Open accessAbstract
OBJECTIVE: To evaluate the association of different contraceptive methods on the incidence and severity of acne. METHODS: Using a de-identified commercial claims database, we performed a retrospective cohort study evaluating the incidence of clinical encounters for acne in the first year after initiation of contraception among female patients aged 12–40 years who were new contraceptive users. To evaluate the association of contraception class with acne severity, a subgroup analysis was performed among a cohort of patients with a history of acne examining the incidence of treatment escalation from topical acne medications to an oral tetracycline-class antibiotic in the year after initiation of contraception. RESULTS: Among new contraceptive users with no history of acne (N=336,738), compared with combined oral contraceptives (OCs), the copper intrauterine device (IUD) (hazard ratio [HR] 1.14; 95% CI 1.01–1.29) and levonorgestrel IUDs (HR 1.09; 95% CI 1.03–1.16) were associated with increased risk of clinical encounters with acne. Among those with a history of acne (n=21,178), compared with combined OCs, the copper IUD (HR 1.44; 95% CI 1.00–2.06) and levonorgestrel IUDs (HR 1.34; 95% CI 1.10–1.64) were associated with increased risk of treatment escalation from topical acne medications to an oral tetracycline class antibiotic. CONCLUSION: Combined OCs appear to be associated with a modest (or small) protective effect with respect to incident acne and treatment escalation compared with other contraceptive methods. However, absolute differences between contraceptive methods were small.
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Progestin-only contraceptive pills, intramuscular injections, intrauterine devices, or subcutaneous implants may worsen acne.
“Progestin-only oral contraceptive pills, intramuscular injections, intrauterine devices, or subcutaneous implants may worsen acne.196,197”
From Guidelines of care for the management of acne vulgaris (2024) · cites this paper as [196]
The Results report more acne encounters after switching from combined pills to progestin-only pills, levonorgestrel IUDs, or an etonogestrel implant. The Introduction also reports a prior survey suggesting that injections, implants, and hormonal IUDs worsened acne. However, this paper's new-user analysis found fewer incident acne encounters with DMPA injections and implants, and switching to DMPA was not associated with a significant increase; the blanket claim is therefore not supported by its findings for every listed method. (LLM, conf=0.86)
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InfluentialHormonal Intrauterine Devices and Acne
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- Authors
- Barbieri, J. S., Mitra, N., Margolis, D. J., Harper, C. C., Mostaghimi, A., & Abuabara, K.
- Affiliations
- Brigham and Women's Hospital (US)
- ORCID
- Venue
- Obstetrics & Gynecology
- Published
- 2020-06
- Volume
- 135
- Issue
- 6
- Pages
- 1306-1312
- ISSN
- 0029-7844 (ISSN-L)
- PMC
- PMC7263356
- OpenAlex
- W3021572880
- Cited by
- 22
- References
- 29
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 10 · 2023: 1 · 2022: 3 · 2021: 2 · 2020: 1
- FWCI
- 1.28
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- other-oa
- Locations
- Obstetrics and Gynecology (publishedVersion, other-oa)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (P30AR069589, T32AR007465)
- Topics
- Health Sciences › Medicine › Dermatology › Acne and Rosacea Treatments and Effects
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Health Sciences › Medicine › Dermatology › Dermatologic Treatments and Research
- Keywords
- acne, contraception, combined oral contraceptives, copper intrauterine device, levonorgestrel-releasing intrauterine system, acne severity, tetracycline antibiotics, female patients
- MeSH terms
- Acne Vulgaris, Adolescent, Adult, Child, Contraception, Contraceptive Agents, Female, Contraceptives, Oral, Combined, Female, Humans, Intrauterine Devices, Copper, Intrauterine Devices, Medicated, Retrospective Studies, United States, Incidence, Databases, Factual, Levonorgestrel, Young Adult
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